However, all patients with gonorrhea or chlamydia should be retested 3 months after treatment, owing to high rates of repeat exposure and reinfection, and to detect rare cases of delayed treatment failure. Test of cure is not necessary for genital or rectal infection treated with a recommended regimen but may be considered for pharyngeal infection, especially if treated with a regimen other than ceftriaxone. Cefixime in a single oral dose of 800 mg is recommended for expedited (unobserved) treatment of patients’ sex partners. A1b, A1c Gentamicin alone is unreliable against pharyngeal infection, A2 but azithromycin 2 g appears to be effective. A1 When cephalosporin allergy or resistance requires an alternative regimen, single dose gentamicin (240 mg intramuscularly) plus azithromycin (2 g orally) is recommended. If chlamydia has not been excluded, ceftriaxone or cefixime should be followed by 100 mg oral doxycycline twice daily for 7 days azithromycin (1 g orally) may be substituted in patients who are unlikely to comply with the doxycycline regimen. When ceftriaxone is not available or intramuscular injection is refused, a single 800 mg oral dose of cefixime may be substituted, although data for this regimen are limited and efficacy against pharyngeal infection is uncertain. British guidelines advise treatment with 1 g ceftriaxone alone, Australia recommends 500 mg ceftriaxone plus 1 g azithromycin, and doses of ceftriaxone as high as 4 g IV are sometimes used in China. 15, 15b Guidelines elsewhere remain variable and in flux. ![]() ![]() Lee Goldman MD, in Goldman-Cecil Medicine, 2020 Treatment RegimensĬDC now recommends treating uncomplicated gonorrhea with 500 mg intramuscular ceftriaxone alone but adding doxycycline (100 mg twice daily for 7 days) in patients who either have chlamydial infection or in whom chlamydia has not been excluded ( Table 283-1).
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