Gonococcal Infection & Syphilis Advisory for Healthcare Providers

Updated Treatment Guidelines for Gonococcal Infection and Syphilis Screening Recommendations

Posted March 2, 2021. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

In December, the Centers for Disease Control and Prevention (CDC) announced changes to the treatment guidelines for gonococcal infections and treatment for presumptive gonorrhea and chlamydia co-infections. Dual therapy for treatment of gonorrhea is no longer indicated due to growing concerns of antibiotic resistance, and azithromycin should only be given if gonorrhea has been ruled out at all sites of potential exposure.

The new recommendations are as follows:

  1. Treat uncomplicated gonorrhea infections with a one-time dose of 500 mg IM ceftriaxone, or 1 gm IM ceftriaxone if patient’s weight is >300 lbs.
    • If IM ceftriaxone is unavailable, one-time dose of 800 mg oral cefixime can be given. This therapy is not recommended for pharyngeal gonococcal infections.
  2. Presumptively treat gonorrhea and/or chlamydia, or confirmed gonorrhea and chlamydia co-infections, with 500 mg IM ceftriaxone AND 100 mg doxycycline BID for seven days.
  3. Treat partners of confirmed cases of gonorrhea with 800 mg oral cefixime. Add 100 mg doxycycline BID for seven days if the original patient was co-infected with gonorrhea and chlamydia, or their chlamydia status is unknown.

For patients with cephalosporin allergies, the treatment recommendations (single dose 240 mg IM gentamicin AND 2 g azithromycin) remain unchanged in the new guidelines.

Patients should be tested three months after treatment, except in cases of pharyngeal gonorrhea. Patients with pharyngeal gonorrhea should be retested seven to fourteen days after treatment.

If a patient is suspected to have cephalosporin treatment failure, please contact Spokane Regional Health District’s (SRHD) HIV/STD Prevention program at 509.324.1494 and collect a specimen for culture and sensitivity to be performed.

Additionally, syphilis remains a public health concern in Spokane County. Due to the sustained increase in syphilis incidence over the past five years, SRHD now recommends ALL patients that present with sexual health concerns or request routine sexual health screenings should be screened for HIV and syphilis, particularly if they have not been screened in the last 12 months. Patients should also be screened for HIV and syphilis at pregnancy confirmation, or if they have tested positive for any other sexually transmitted infection and were not screened at the time of initial diagnosis.

Questions or need more information? Contact SRHD’s HIV/STD Prevention Program at 509.324.1494.