Treatment of Gonorrhoea
The treatment of gonorrhoea involves antibiotics aimed at clearing the infection and preventing complications. Due to the growing threat of antimicrobial resistance, the treatment of gonorrhoea must follow up-to-date clinical guidelines to ensure both effectiveness and public health safety. Immediate treatment is essential not only to relieve symptoms but also to stop the spread to others and prevent long-term health consequences such as infertility or pelvic inflammatory disease.
Neisseria gonorrhoeae causes gonorrhoea, a bacterial infection. Although curable, the bacteria have developed resistance to many antibiotic classes over time. Health authorities such as the World Health Organization (WHO), Centres for Disease Control and Prevention (CDC), and national public health agencies continually monitor and update treatment regimens.
Recommended First-Line Treatment
Most countries now recommend an updated single-dose regimen. As of current international guidance:
Ceftriaxone (a third-generation cephalosporin) is the cornerstone:
500 mg to 1 g intramuscular injection in a single dose
Some healthcare providers use a higher dose to address concerns about resistance
Doctors add doxycycline 100 mg twice daily for 7 days if they have not ruled out chlamydia co-infection
This dual treatment approach ensures both infections are cleared simultaneously, as co-infection with chlamydia is common.
Alternatives for Allergic Patients
For patients with severe allergies to cephalosporins:
Gentamicin (240 mg intramuscular) + azithromycin (2 g orally) may be used
These alternatives are less effective and generally reserved for cases where ceftriaxone cannot be used
Desensitisation protocols may be available in specialist centres for patients with critical antibiotic allergies.
Special Considerations by Site of Infection
Gonorrhoea may infect different body parts, and the site may influence the treatment approach:
Genital and Urethral Infections
Standard ceftriaxone therapy is effective
Resolution typically occurs within a few days
Sexual abstinence is advised until 7 days after treatment completion
Rectal Infections
Also treated with standard ceftriaxone regimen
Symptoms may persist slightly longer
Retesting may be recommended if symptoms persist after therapy
Pharyngeal Infections
Harder to eradicate
Require strict adherence to guidelines
Post-treatment testing may be advised due to higher treatment failure rates
Disseminated Gonococcal Infection (DGI)
Requires hospital admission and intravenous antibiotics
Ceftriaxone 1–2 g IV daily for 7–14 days is typical
Doctors may follow oral step-down therapy once they observe improvementd
Prompt recognition of DGI is essential to avoid joint destruction or systemic complications.
Follow-Up and Retesting
To ensure eradication and prevent reinfection:
Doctors do not routinely require a test of cure for urogenital gonorrhoea unless symptoms persist
Pharyngeal infections should be re-tested after 1–2 weeks
Doctors strongly recommend re-screening all patients after 3 months because of high reinfection rates
Sexual partners from the past 60 days should also be notified, tested, and treated if necessary—even if asymptomatic.
Abstinence After Treatment
It is essential to avoid any sexual contact:
For at least 7 days after completing treatment
Until all sexual partners have also been treated
To reduce the risk of passing on or acquiring other STIs
Use condoms consistently in future sexual encounters to prevent recurrence.
Partner Notification and Public Health
Effective management includes notifying recent partners:
Trained health advisors often support partner notification
Some clinics offer anonymous notification services
This process breaks the reinfection cycle and protects broader community health
Partner management is a cornerstone of gonorrhoea control efforts.
Rising Resistance and the Need for Vigilance
The evolution of antibiotic-resistant gonorrhoea is a global concern. Resistance has developed against:
Penicillin
Tetracycline
Fluoroquinolones
Macrolides (e.g. azithromycin)
Some strains are now showing decreased susceptibility to ceftriaxone
Surveillance systems like the WHO Gonococcal Antimicrobial Surveillance Programme (GASP) monitor trends to inform treatment updates.
Patients who do not respond to standard treatment must undergo further testing, including culture and sensitivity, to guide tailored therapy.
Prevention After Treatment
Doctors recommend the following preventive steps after successful treatment:
Use condoms consistently and correctly
Limit the number of sexual partners
Attend regular sexual health check-ups
Encourage partner testing
Avoid sex when symptomatic
Vaccines for gonorrhoea are currently under development, offering hope for long-term prevention in high-risk populations.
Conclusion | Treatment of Gonorrhoea
The treatment of gonorrhoea is highly effective when managed with appropriate antibiotics and partner follow-up. However, rising resistance poses a threat to future treatment success. To ensure continued control of the infection, it is critical to follow up-to-date guidelines, encourage safe sex practices, and support partner notification. With coordinated care, the treatment of gonorrhoea remains a powerful tool in protecting individual and public health.
