-Dual treatment is 2/2 to growing resistance of Neisseria Gonorrhea to cefixime and Ceftriaxone and other antibiotics not because of chlamydia.
-Only one regimen, dual treatment with ceftriaxone and azithromycin, is recommended by the CDC for the treatment of gonorrhea in the United States.
-Ceftriaxone 250mg IM x 1 and Azithromycin 1g po x1.
-Retest patient at 3-6 months due to a high rate of reinfection.
-Treat the partner.
** Doxycycline is no longer recommended as an alternative to Azithromycin for the dual treatment of gonorrhea. This is because of growing resistance by gonorrhea against tetracyclines.
** NAAT for diagnosis.
** Culture if you are worried about resistance.
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Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum
Recommended Regimen
- Ceftriaxone 250 mg IM in a single dose
PLUS - Azithromycin 1g orally in a single dose
As dual therapy, ceftriaxone and azithromycin should be administered together on the same day, preferably simultaneously and under direct observation.
References
https://www.cdc.gov/std/tg2015/gonorrhea.htm [CDC 2015 treatment update]