CDC Updates Gonorrhea Treatment Guidelines

The Centers for Disease Control and Prevention (CDC) has updated its guidelines for the use of ceftriaxone monotherapy for uncomplicated gonorrhea.

“This update provides the rationale for the change in gonorrhea treatment recommendations to a higher dose (500 mg) of ceftriaxone and removal of azithromycin from the recommended regimen,” they wrote.

They cite the rising concern of azithromycin resistance in N. gonorrhoeae as a major factor contributing to the change in recommendation, saying “nationally, the percentage of N. gonorrhoeae isolates with reduced susceptibility increased more than 7-fold over 5 years (from 0.6% in 2013 to 4.6% in 2018).”

Other recommendations include:

  • Sexual partners may be treated with a single 800 mg oral dose of cefixime in cases where concurrent chlamydial infection has been excluded and when gonococcal expedited partner therapy is permissible.
  • When cephalosporin treatment failure is suspected, relevant specimens for antimicrobial susceptibility testing should be obtained and the case should be reported to CDC.
  • A test-of-cure in not necessary in patients with uncomplicated urogenital or rectal gonorrhea treated with recommended regimens but is recommended for those with pharyngeal gonorrhea.

“Continuing to monitor for emergence of ceftriaxone resistance through surveillance and health care providers’ reporting of treatment failures will be essential to ensuring continued efficacy of recommended regimens.,” the group concluded.


—Michael Potts



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: http://dx.doi.org/10.15585/mmwr.mm6950a6