Question 9 - Gonococcal Infections Question Bank

Gonococcal InfectionsQuestion 9/15

A 24-year-old cisgender woman is diagnosed with rectal Neisseria gonorrhoeae infection on a routine screening nucleic acid amplification test (NAAT). She has no symptom. The rectal NAAT is negative for Chlamydia trachomatis. In addition, pharyngeal swabs and urine NAATs are negative for gonorrhea and chlamydia. She weighs 72 kg and has no antibiotic allergies.

What regimen should be used to treat this rectal N. gonorrhoeae infection?

Ceftriaxone 250 mg in a single intramuscular dose

Ciprofloxacin 500 mg orally in a single dose plus doxycycline 100 mg orally twice daily for 7 days

Cefixime 400 mg orally once daily for 7 days plus azithromycin 1 g orally in a single dose

Ceftriaxone 500 mg in a single intramuscular dose

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Question Last Updated
March 29th, 2022

Table 1. Update to CDC STD Treatment Guidelines for Gonococcal Infection, 2020
Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Recommended Regimen if Chlamydia infection has been excluded

Ceftriaxone

Tradename:Rocephin

*500 mg IM as a single dose for persons weighing <150 kg (300 lb)

This regimen is appropriate if chlamydia infection has been excluded.

Note: *For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.

Recommended Regimen if chlamydia infection has not been excluded

Ceftriaxone

Tradename:Rocephin

*500 mg IM as a single dose for persons weighing <150 kg (300 lb)

Doxycycline

Tradename:Doryx, Vibramycin

100 mg orally twice daily for 7 days+

This regimen is appropriate if chlamydia infection has not been excluded. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia instead of doxycycline.

Note: *For persons weighing ≥150 kg (300 lb), 1 g of IM ceftriaxone should be administered.

Alternative Regimen if ceftriaxone is not available

Gentamicin

Tradename:Garamycin

240 mg IM as a single dose

Azithromycin

Tradename:Zithromax

2 g orally as a single dose+

Alternative Regimen if ceftriaxone is not available

Cefixime

Tradename:Suprax

800 mg orally as a single dose

Note: If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, azithromycin 1 g as a single dose is recommended to treat chlamydia.

Source: 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;69:1911-6. [PubMed Abstract]

Table 1. 2021 STI Treatment Guidelines: Gonococcal Infections
Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Recommended Regimen if Chlamydial Infection Excluded

Ceftriaxone

Tradename:Rocephin

500 mg* IM in a single dose for persons weighing <150 kg

Note: *For persons weighing ≥150 kg, ceftriaxone 1 g IM should be administered.

Recommended Regimen if Chlamydial Infection Has Not Been Excluded

Ceftriaxone

Tradename:Rocephin

500 mg* IM in a single dose for persons weighing <150 kg

Doxycycline

Tradename:Doryx, Vibramycin

100 mg orally twice daily for 7 days+

During pregnancy, oral azithromycin 1 gram in a single dose is recommended to treat chlamydia.

Note: *For persons weighing ≥150 kg, ceftriaxone 1 g IM should be administered.

Alternative Regimen if Ceftriaxone is Not Available

Gentamicin

Tradename:Garamycin

240 mg IM in a single dose

Azithromycin

Tradename:Zithromax

2 g orally in a single dose+

Alternative Regimen if Ceftriaxone is Not Available

Cefixime

Tradename:Suprax

800 mg orally in a single dose

Note: If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days. During pregnancy, oral azithromycin 1 g in a single dose is recommended to treat chlamydia.

Source: Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Gonococcal infections. MMWR Recomm Rep. 2021;70(No. RR-4):1-187. [2021 STI Treatment Guidelines]

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Gonococcal InfectionsQuestion 9/15

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What regimen should be used to treat this rectal N. gonorrhoeae infection?

Table 1. Update to CDC STD Treatment Guidelines for Gonococcal Infection, 2020
Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Ceftriaxone

Ceftriaxone

Doxycycline

Gentamicin

Azithromycin

Cefixime

Table 1. 2021 STI Treatment Guidelines: Gonococcal Infections
Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Ceftriaxone

Ceftriaxone

Doxycycline

Gentamicin

Azithromycin

Cefixime

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Gonococcal InfectionsQuestion 9/15

Questions in Topic

What regimen should be used to treat this rectal N. gonorrhoeae infection?

Table 1. Update to CDC STD Treatment Guidelines for Gonococcal Infection, 2020Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Ceftriaxone

Ceftriaxone

Doxycycline

Gentamicin

Azithromycin

Cefixime

Table 1. 2021 STI Treatment Guidelines: Gonococcal InfectionsTreatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Ceftriaxone

Ceftriaxone

Doxycycline

Gentamicin

Azithromycin

Cefixime

Steps to Acquire CE for this Question Bank Topic:

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Table 1. Update to CDC STD Treatment Guidelines for Gonococcal Infection, 2020
Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum

Table 1. 2021 STI Treatment Guidelines: Gonococcal Infections
Treatment of Uncomplicated Gonococcal Infection of the Cervix, Urethra, or Rectum