Gonorrhea Treatment: Choosing Ceftriaxone and Azithromycin While Managing Resistance and Contact Notification

Gonorrhea, caused by Neisseria gonorrhoeae, is one of the most common sexually transmitted infections worldwide. In recent years, we have observed a concerning increase in antibiotic resistance, complicating its treatment. This phenomenon has led to the necessity of reviewing and updating treatment guidelines to ensure therapeutic efficacy and prevent reinfection.

Antibiotics of Choice

The standard treatment for gonorrhea has been dual therapy with ceftriaxone and azithromycin. Ceftriaxone, an antibiotic from the extended-spectrum cephalosporin class, is generally administered in a single intramuscular dose of 250-500 mg. Azithromycin, on the other hand, is given in a single oral dose of 1-2 g. This combination has shown high cure rates and has contributed to reducing resistance to cephalosporins internationally [1].

However, the emergence of ceftriaxone and azithromycin-resistant strains has been reported in several regions, underscoring the need to develop new antimicrobials and treatment strategies [2]. In this context, zoliflodacin has emerged as a promising candidate in clinical development [1].

Contact Notification and Prevention of Reinfection

Controlling gonorrhea not only depends on effective treatment but also on contact notification and the prevention of reinfection. Contact notification is crucial for identifying and treating the sexual partners of infected patients, thereby reducing the spread of the infection. Strategies such as expedited partner therapy (EPT) have proven effective in improving the treatment of sexual partners [3].

Moreover, the implementation of enhanced contact notification programs has shown an increase in case detection, which is essential for outbreak control [4]. Continuous surveillance and follow-up of contacts are essential components for the effective management of gonorrhea and the prevention of reinfection.

Conclusions

The treatment of gonorrhea faces significant challenges due to the increasing resistance to antibiotics. Dual therapy with ceftriaxone and azithromycin remains the standard, but the emergence of resistant strains requires constant vigilance and the development of new treatments. Contact notification and expedited partner therapy are key strategies for controlling the spread of the infection and preventing reinfection. Collaboration among healthcare professionals and the implementation of effective public health policies are essential to address this global health issue.

Referencias

• [1] Antimicrobial Resistance in Neisseria gonorrhoeae and Treatment of Gonorrhea
• [2] Challenges with gonorrhea in the era of multi-drug and extensively drug resistance - are we on the right track?
• [3] Improving Women's Health and Combatting Sexually Transmitted Infections Through Expedited Partner Therapy
• [4] Increase in Gonorrhea Incidence Associated With Enhanced Partner Notification Strategy

Created 6/1/2025