Gonorrhea treatment for newly diagnosed and antibiotic-resistant cases
In this chapter, we’ll talk about gonorrhea treatment.
Previous chapters have covered symptoms, signs, the odds of getting the condition , and testing —all necessary tools for diagnosing the condition so treatment can be given as soon as possible.
In the overwhelming majority of cases, gonorrhea is an easily treatable condition that’s curable with single-dose antibiotic therapy. Treatment should be given as soon as gonorrhea is suspected based on signs and symptoms. If left untreated, gonorrhea may lead to permanent damage of the reproductive system (mostly of females but possibly of males).
In this section, we summarize the options (medication choices and duration) for treating gonorrhea, including resistant cases, in the tables. This is followed by frequently asked questions answered by an expert doctor.
Let’s move on!
Treatment of newly diagnosed gonorrhea
This table summarizes gonorrhea treatment. The initial treatment is the same regardless of the anatomic area gonorrhea is affecting (oral, rectal, urethral, or vaginal).
The table presents information in two columns:
| Ideal treatment (gold standard) | Alternative Treatment |
|---|
Newly diagnosed cases | Ceftriaxone (250mg) single dose, intramuscular PLUS
Azithromycin (1g) Single dose, oral | If Ceftriaxone is not available
Cefixime (400mg) single dose, oral PLUS Azithromycin (1g) single dose, oral
OR
Ceftizoxime (500mg) single dose, intramuscular PLUS Azithromycin (1g) single dose, oral
OR
Cefoxitin (2g) single dose, intramuscular PLUS Probenecid (1g) single dose, oral PLUS Azithromycin (1g) single dose, oral
If allergic to Ceftriaxone
Gentamicin (240mg) single dose, intramuscular PLUS Azithromycin (2g) single dose, oral |
Treatment of antibiotic-resistant gonorrhea
This table summarizes the treatment for resistant gonorrhea.
The ability of bacteria to survive and multiply after antibiotic treatment that killed the same bacteria in the past is called antibiotic resistance. Gonorrhea has developed the ability to resist almost all antibiotics.
A gonorrhea infection is considered resistant if:
- Symptoms persist five days after adequate treatment and sexual abstinence
- The patient (who has been sexually abstinent) remains gonorrhea-positive on a culture three days after treatment is completed or on an NAAT test seven days after the completion of treatment
- Antimicrobial susceptibility testing reveals cephalosporin resistance (meaning resistance to a group of first-line antibiotics)
The table below summarizes the treatment options in resistant-gonorrhea cases.
| Medications for ceftriaxone- resistant gonorrhea | Medication for ceftriaxone-resistant gonorrhea if allergic to gentamicin and gemifloxacin |
|---|
Resistant gonorrhea treatment | Gentamicin (240mg) single dose, intramuscular PLUS Azithromycin (2g) single dose, oral
OR
Gemifloxacin (320mg) single dose, oral PLUS Azithromycin (2g) single dose, oral | Ceftriaxone (250mg) single dose, intramuscular PLUS Azithromycin (2g) Single dose, oral Please note that even in cases of ceftriaxone resistance, that drug is still advised, but in combination with a higher dose of azithromycin. |
Frequently Asked Questions
Here we summarize real patients’ questions, grouped by topic, and Dr. Fuzayloff’s answers to them. “Dr. F” (his patients’ name for him) has been an STD doctor for over two decades in Midtown Manhattan, NYC.
I have gonorrhea symptoms and signs. Can I be treated for gonorrhea while I’m waiting for my test results? 
Yes. Patients may start treatment before their test results come back to prevent further transmission and complications.
This approach is called empiric treatment. The treatment is prescribed based on the following:
- The disease signs and symptoms the patient is experiencing
- The patient having had sexual contact with a gonorrhea-positive partner
I’ve been diagnosed with gonorrhea. Can I get treatment for my partner?
Yes. Back in 2006, the CDC adopted the approach of expedited partner therapy (EPT). This therapy was designed for partners of gonorrhea-positive individuals. One oral dose of cefixime is prescribed to the partner without medical evaluation. This approach prevents reinfection (which occurs in 11% of cases) and possible gonorrhea-related complications. However, the use of EPT is limited under current CDC recommendations:
EPT as an alternative
Ideally, the partner needs to get injectable ceftriaxone rather than oral cefixime (which is less effective). So, ETP is considered only for people who have no access to the proper testing and treatment.
No EPT for homosexual males
EPT gonorrhea treatment is not advised for homosexual males because they’re at higher risk of getting various STIs, making proper medical examination and STD testing important.
EPT to partners within 60 days
EPT is limited to the sexual partners that a gonorrhea-positive patient had within the last 60 days.
How effective is gonorrhea treatment?
Gonorrhea treatment is very effective. Gonorrhea is considered a curable infection.It’s very important to use the right medication dosage and the right combination of medications.
The tables below show the effectiveness of the gold-standard treatment and that of the alternative treatments. The difference in effectiveness can be significant, especially for oral and rectal gonorrhea.
| Medication given | Anatomic area | Effectiveness |
|---|
Gold standard treatment
Ceftriaxone 250mg + Azithromycin 1g (first-line therapy) | Genital | 98% |
| Oral | 94% |
| Rectal | 98% |
Alternative treatment
Gentamicin 240mg + Azithromycin 2g (second-line therapy) | Genital | 96% |
| Oral | 80% |
| Rectal | 90% |
What are my odds of having antibiotic-resistant gonorrhea?
With gold-standard gonorrhea treatment, the chance of gonorrhea resistance in the United States is only 0.1%–0.3%.
The odds are significantly worse (up to 5%) in Japan, India, South Korea, and other Asian countries. If for any reason you were treated with second-line alternative medications, the chance that you’ll have antibiotic-resistant gonorrhea can be up to 20%.
What is antibiotic resistance?
Antibiotic resistance is an altered response of the bacteria to the treatment. The gonorrhea bacteria are able to survive and replicate after the antibiotic treatment that’s supposed to kill them. The patient continues to experience symptoms and/or remains gonorrhea-positive on a culture three days after the completion of treatment or on an NAAT test seven days after the treatment of completion).
*If you have antibiotic-resistant gonorrhea, sensitivity testing can be performed to direct the treatment.
I was diagnosed with gonorrhea and was treated for it. Do I need to be retested?
No. No retesting is necessary after the treatment if these criteria are satisfied:
- You received the gold-standard treatment (one ceftriaxone shot and one-time azithromycin pills)
- You didn’t have sex for seven days after finishing the treatment
Statistically, 11% of people are reinfected with gonorrhea within three months. The CDC considers gonorrhea-positive persons high risk and advises that they be screened for gonorrhea and all other STDs three months after the treatment.
When can I expect improvement in my gonorrhea signs and symptoms?
Regular gonorrhea cases (most people)
Usually, gonorrhea symptoms such as penile pain disappear within a few days (on average, two days; and almost always within five days). In women, bleeding between periods usually improves by the next period.
Complicated (advanced) gonorrhea cases (rare)
In complicated cases where the patient is experiencing pelvic and/or testicular pain, it may take up to two weeks to clear all signs and symptoms associated with gonorrhea.
I had gonorrhea treatment and I feel much better now. How soon after treatment can I have sex again because I’m no longer infectious?
You may have sex seven days after completion of the prescribed treatment. Post-treatment testing is not recommended if you maintained sexual abstinence and don’t experience any gonorrhea symptoms.
*Remember: All sexual partners of the gonorrhea-positive person (within the last 60 days) should be treated to prevent possible reinfection.
Where can I get gonorrhea treatment?
You can get gonorrhea treatment at almost any health facility, including these:
- Primary care centers
- STD clinics
- Sexual health clinics
- Urgent care clinics
- A gynecologist’s or urologist’s office
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