Gonorrhoea (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
Warning
- Referral to Highland Sexual Health should be made for treatment, partner notification and follow up.
- Diagnosis is usually by PCR/NAAT of urine or swab (vaginal, throat, rectal), depending on sexual history and anatomy.
- Testing should always be carried out prior to treatment initiation.
- Prior to treatment a charcoal swab from the site of infection should be taken to establish antimicrobial sensitivities (no need to await the result prior to treatment).
- Full STI screening should be offered to also include chlamydia, HIV and syphilis.
- Partners will require testing +/- treatment.
- Test of cure should be performed 3 weeks after treatment (no sooner) as resistant strains are increasing.
Patient information is available here: https://highlandsexualhealth.co.uk/stis/gonorrhoea.
Drug details
Gonorrhoea (uncomplicated ano-genital and pharyngeal infection).
Preferred option for patients who are pregnant or breastfeeding.
Ceftriaxone (intramuscular) 1 gram
As a single dose
Alternatives suitable for allergy, needle phobia or other absolute or relative contraindications.
Give dual therapy to avoid treatment failure, especially in pharyngeal infections.
Cefixime 400mg
PLUS
Azithromycin 2 gram
As a single dose
In proven beta-lactam allergy.
If known severe renal impairment (eGFR below 30) contact Sexual Health or Microbiology.
Gentamicin (intramuscular) 240mg
PLUS
Azithromycin 2 gram
As a single dose