Citation: Sexually Transmitted Diseases Treatment Guidelines, 2010. CDC Morbidity and Mortality Weekly Report: December 17, 2010 / Vol. 59 / No. RR-12
Summary:
The CDC recently changed the recommended gonorrhea treatment regimen to Ceftriaxone 250 mg IM in a single dose PLUS either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. This decision was made due to the following factors: 1) increasing global distribution of isolates demonstrating cephalosporin resistance, 2) reports of ceftriaxone 125mg treatment failures, 3) the need for better efficacy against gonococcal pharyngeal infections, which are often unrecognized, and 4) to provide a single treatment regimen regardless of the anatomic site of infection. Alternative regimens include Cefixime 400 mg orally in a single dose PLUS either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days OR cefpodoxime 400 mg orally in a single dose PLUS either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days. Patients with a prior severe reaction to penicillin may be treated with azithromycin 2 g orally. Due to the potential for N. gonorrhoeae to develop resistance to macrolides, use of this regimen should be used with caution and providers treating such patients could consider consulting an infectious disease specialist. Clinicians should advise patients to refer all sex partners in the 60 days prior to the onset of symptoms or diagnosis for evaluation and treatment, and patients themselves should be retested 3 months after treatment to screen for reinfection.
Commentary: An important change that can affect many of our patients, and a reminder that antibiotic resistance is a reality.
By: Christopher A Cox, MS3, UCSF Medical School
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