• 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
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
Azithromycin 2 gram

As a single dose

Editorial Information

Last reviewed: 27/02/2023

Next review date: 27/02/2026

Author(s): Antimicrobial Management Team.

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT125