Therapeutic target
- Elimination of the pathogens
- Avoidance of complications
- Partner management, i.e., infected partners, if any, must be located and treated (contacts must be traced for 3 months) [see guidelines below: 2].
Treatment recommendations
- Antibiotic therapy [see guidelines below: 1]:
- Uncomplicated gonorrhea: 1 g ceftriaxone i.m. (first-line agent) or i.v., combined with azithromycin 1.5 g,
- If i.m. or i.v. administration not possible: in case of infestation of cervix (neck of the uterus), urethra (urethra) or rectum (rectum): replace ceftriaxone with cefixime 800 mg (see further notes).
- Alternatively, in case of proven sensitivity: p.o. administration of cefixime 800 mg, ciprofloxacin 500 mg, ofloxacin 400 mg or azithromycin 1.5 g – each as a single dose.
- Gonococcal conjunctivitis (conjunctivitis) in adults: Ceftriaxone, 1 g i.v./i.m. once; additionally perform ocular irrigation.
- Uncomplicated gonorrhea: 1 g ceftriaxone i.m. (first-line agent) or i.v., combined with azithromycin 1.5 g,
Further notes
- Due to reduced bioavailability, cefixime should not be applied in pharyngeal infestation (infestation of the pharynx)!
- Europe-wide decreasing sensitivity to the antibiotic cefixime (isolated treatment failure) and increasing minimum inhibitory concentrations for ceftriaxone.
- In pharyngeal infestations, an antispetic mouthwash can reduce the number of germs in the mouth and throat, making transmission more difficult.
- The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) presents the latest figures from 2017: in 3,248 gonococcal isolates from 27 EU/EEA countries, for the second year in a row, no resistance was found to ceftriaxone but 7.5 percent to azithromycin.
- In Germany, the high-level azithromycin-resistant N. gonorrhoeae strain “HL-AziR-NG” was detected in a man for the first time in 2019. The neisseria were also resistant to tetracyclines but produced a beta-lactamase. Treatment with ceftriaxone 1 g i.v. and azithromycin 1.5 g per os, may therefore have been successful. The partner, who was also infected and treated analogously, was cured after the above therapy; from the man, the result was not yet available at the time of publication.
- Note the frequent co-infection with chlamydia or other STDs (sexually transmitted diseases; sexually transmitted diseases).
