CDC Update to Gonococcal Infection Treatment

Posted on Feb 1, 2021 in Announcements | 0 comments

CDC Update to Gonococcal Infection Treatment

Neisseria gonorrhoeae is an important cause of sexually transmitted diseases and can lead to complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility. While effective treatment can prevent complications and transmission, N. gonorrhoeae can rapidly develop resistance to antibiotics.

In December 2020, the CDC has updated its guidelines on gonococcal treatment. The CDC now recommends a single 500 mg intramuscular (IM) dose of ceftriaxone for treatment of uncomplicated gonococcal infection of the urogenital, anorectal, and/or pharyngeal region. For patients weighing 150 kg or more, 1 gram of ceftriaxone IM is recommended. In cases where chlamydial infection remains in the differential, doxycycline 100 mg orally twice daily for 7 days is recommended. Prior guidelines from 2010 recommended a single 250 mg IM dose of ceftriaxone and a single 1 gram dose of oral azithromycin.

This change in recommendation comes from increasing N. gonorrhoeae resistance to azithromycin. In the United States, N. gonorrhoeae resistance to azithromycin increased from 0.6% in 2013 to 4.6% in 2018. This, along with additional evidence concerning for reduced efficacy of azithromycin to treat chlamydial infections, especially rectal infections, has led to the decrease in strength of recommendation for azithromycin. In pregnant patients, oral azithromycin 1 gram as a single dose is still recommended to treat chlamydia. Meanwhile, N. gonorrhoeae remains susceptible to ceftriaxone. However, pharmacokinetic and pharmacodynamic studies demonstrate the need for higher ceftriaxone doses to avoid treatment failure, especially for pharyngeal gonorrhea treatment. Monitoring for emergence of ceftriaxone resistance will be essential for ensuring continued efficacy of the recommended regimens.


St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916. DOI: icon

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