Treatment of Gonorrhea: Modern approaches

The treatment of this extremely common sexually transmitted disease has become very difficult for the past decade. Neisseria gonorrhoeae – the causative organism has a particularly strong proclivity to develop antibiotic resistance, and many older treatment regimens have become obsolete. So, what are the current best practices for treatment?

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Read more: Gonorrhea Facts

Gonorrhea Medicine

  The current first-line treatment of genital gonorrhea involves:

  • A single dose of a cephalosporin antibiotic (most commonly ceftriaxone 250 mg) given via intramuscular injection
  • Single-dose azithromycin (Zithromax) 1 g.

This regimen is very quick and very convenient, particularly because it is often given immediately in the clinic. Those more scared of needles opt for oral cefixime 400 mg since ceftriaxone is only available in the form of an intramuscular injection. It is important to note that cefixime is not as effective for the various types of infections gonorrhea causes outside the reproductive system (throat infections, bacterial arthritis and etc.), and is thus only seen as an alternative when ceftriaxone is not available.

Read More: Gonorrhea Symptoms

All gonorrhea treatment regimens also take into account the coexistence of chlamydia. These two infections often occur together and are thus treated together.

Alternative treatment of Gonorrhea

An alternative treatment course would incorporate ceftriaxone with a tetracycline antibiotic, most commonly doxycycline. This combination is no longer recommended by both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) due to antibiotic resistance. It is generally considered “good practice” to have the local antibiotic resistance characteristics in mind when prescribing. For example, the WHO also states that ceftriaxone or cefixime can be used on their own for treatment provided there is reliable data that the local strain is susceptible to these on their own.

Read More: Why get tested for Gonorrhea

A novel antibiotic for the treatment of gonorrhea is spectinomycin (Trobicin). It is a rarely used antibiotic in the developing world (especially sub-Saharan Africa) due to its cost, having a wholesale cost per dose ranging from 2 to 20 times higher than ceftriaxone or azithromycin. Nevertheless, it can be used as a single treatment, with a 2-gram intramuscular injection enough to fight the most susceptible strains.

There is hope for the treatment of antibiotic-resistant gonorrhea in the future. Research done by the CDC and the National Institute of Health (NIH) has shown that combinations of:

  • Gentamicin plus azithromycin or
  • Gemifloxacin plus azithromycin

 Are more than 99% effective for the treatment of genital gonorrhea. Even better, both of these new combinations are given orally. The CDC has not changed its recommendation, though, noting the significant gastrointestinal side effects of these medications as the cause. With new experimental treatments such as zoliflodacin showing promise, not all is bleak for those with sexually transmitted diseases.

Read More: Gonorrhea in Ghana

References:

https://www.cdc.gov/std/gonorrhea/arg/basic.htm

https://www.who.int/reproductivehealth/publications/rtis/gonorrhoea-treatment-guidelines/en/

https://emedicine.medscape.com/article/218059-treatment#d9

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165062/

https://www.jwatch.org/na47824/2018/11/07/new-oral-antibiotic-treatment-gonorrhea

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