Table 3.

Recommended treatment of uncomplicated anogenital and pharyngeal infections in adults and youth (≥ 9 y of age)

PATIENT GROUP AND INFECTION SITEPREFERRED TREATMENT (DOSE)GRADE OF RECOMMENDATION AND QUALITY OF EVIDENCEALTERNATIVE TREATMENT* (DOSE)GRADE OF RECOMMENDATION AND QUALITY OF EVIDENCE
Patients other than MSM
  • AnogenitalCeftriaxone (250 mg IM, single dose) in combination with azithromycin (1 g orally, single dose)A, II13Spectinomycin (2 g IM, single dose) in combination with azithromycin (1 g orally, single dose)B, III14,15
Cefixime (800 mg, single dose) in combination with azithromycin (1 g orally, single dose)B, II13Azithromycin§ (2 g orally, single dose)B, I1619
  • PharyngealCeftriaxone (250 mg IM, single dose) in combination with azithromycin (1 g orally, single dose)A, II13Cefixime (800 mg, single dose) in combination with azithromycin (1 g orally, single dose)B, II13
Azithromycin§ (2 g orally, single dose)B, I1619
MSM
  • AnogenitalCeftriaxone (250 mg IM, single dose) in combination with azithromycin (1 g orally, single dose)A, II13Cefixime (800 mg, single dose) in combination with azithromycin (1 g orally, single dose)B, II13
Spectinomycin (2 g IM, single dose) in combination with azithromycin (1 g orally, single dose)B, III14,15
Azithromycin§ (2 g orally, single dose)B, I1619
  • PharyngealCeftriaxone (250 mg IM, single dose) in combination with azithromycin (1 g orally, single dose)A, II13Cefixime (800 mg, single dose) in combination with azithromycin (1 g orally, single dose)B, II13
  • IM—intramuscularly, MSM—men who have sex with men.

  • * Alternative treatments are intended for use in cases in which there is a contraindication to the preferred treatment.

  • A 1-g oral dose of azithromycin is preferred over the alternative of a 100-mg oral dose of doxycycline twice daily for 7 d owing to considerable rates of tetracycline-resistant gonorrhea and concerns regarding compliance with a 7-d treatment regimen. Doxycycline is contraindicated in pregnant and breastfeeding women.

  • There is scientific evidence that 800 mg of cefixime is safe and effective in treating gonococcal infections.7,2024 Pharmacodynamic studies have shown that 800 mg of cefixime compared with 400 mg of cefixime increases the period when the free drug concentration exceeds the minimum inhibitory concentration. Therefore, 800 mg might be more effective than the previously recommended 400-mg dose at reducing the risk of gonococcal treatment failure in settings of reduced cephalosporin susceptibility.7,9,25 If cefixime is not available, all cases should be treated with ceftriaxone.

  • § A single 2-g oral dose of azithromycin should only be considered as an alternate treatment option if there is a history of severe allergy to cephalosporins. It is important to recognize the risk of treatment failure when using azithromycin monotherapy for the treatment of gonorrhea. There are also considerable gastrointestinal side effects associated with high-dose azithromycin.