The CDC’s Updated Guidelines on the Treatment of Gonorrhea

Gonorrhea is a common sexually transmitted infection (STI) that can affect anyone who is sexually active. In the U.S., there are over 1.5 million new cases of gonorrhea every year, and it’s most common in people between 15 and 24 years old. 

Gonorrhea can cause infections of the genitals (including the cervix, urethra, and rectum) and the throat. It doesn’t always cause symptoms, so it’s important to get regular STI testing if you’re sexually active.

Gonorrhea can be cured with the right treatment, but some strains of gonorrhea have become resistant to certain antibiotics. If it’s not treated, gonorrhea can lead to serious health problems, like pelvic inflammatory disease (PID) and difficulties getting pregnant (infertility). 

The Centers for Disease Control and Prevention (CDC) monitor new cases of gonorrhea (and other STIs) and publishes treatment guidelines for them. Here we’ll review the CDC’s most recent treatment recommendations for gonorrhea and why they were updated. 

Recommendations from the new CDC gonorrhea treatment guidelines 

Here are the most recent CDC antibiotic treatment recommendations for gonorrhea infections in adults. These are for people with infections that haven’t spread to other parts of the body or caused other health problems. 

Which antibiotics does the CDC recommend for the treatment of gonorrhea? 

First-choice treatment: Ceftriaxone (Rocephin), given as a single shot 

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Alternative (second-choice) treatments, if ceftriaxone isn’t available or you have an allergy to it:

• Gentamicin (Garamycin) shot PLUS azithromycin (Zithromax) pill (one dose of each)

OR

• Cefixime (Suprax) pill (one dose)

If you have a gonorrhea infection involving the throat and can’t use ceftriaxone, you should see an infectious disease specialist. They will review the best treatment options for you.  

Gonorrhea treatment during pregnancy: Ceftriaxone (Rocephin), given as a single shot

If you’re pregnant and can’t take ceftriaxone, you should see an infectious disease specialist to see what treatment options are best for you.

What to do after treatment for gonorrhea?

After treatment, it’s important to avoid any sexual activity for 7 days and until any symptoms have gone away. You should also wait until your sex partners have been tested and treated. Taking these steps will lower your risk of getting reinfected with gonorrhea. 

It’s also a good idea to get tested for other STIs, like chlamydia, syphilis, and HIV.

Repeat testing

Gonorrhea infections in the throat can be harder to cure than genital infections. Because of this, people with throat gonorrhea should have a follow-up test 7 to 14 days after getting treatment. This is called a “test of cure”;’ it makes sure the medication worked. 

The CDC also recommends that anyone treated for gonorrhea should get retested in 3 months, even if their sex partners were treated. This is because there’s a high rate of gonorrhea reinfection in people who had it before. 

Why are these changes necessary?

The bacteria that cause gonorrhea easily develop resistance to certain antibiotics. When this happens, it’s called antibiotic resistance, and it means that a different medication must be used to treat the infection.

What new antibiotic resistance information has emerged?

In the U.S., various federal, state, and county/city organizations work together to monitor and fight antibiotic-resistant gonorrhea. Examples include:  

• Gonococcal Isolate Surveillance Project (GISP) and enhanced Gonococcal Surveillance Project (eGISP)

• STD Surveillance Network (SSuN)

• Strengthening the United States Response to Resistant Gonorrhea (SURRG)

• Antibiotic Resistance Laboratory Network (AR Lab Network)

Most recently, gonorrhea strains have become more resistant to two antibiotics called cefixime generic and azithromycin. Because of this, the CDC stopped recommending cefixime as a first-choice treatment for gonorrhea.

Here are some past gonorrhea treatments that no longer work because of antibiotic resistance:

• Penicillin

• Tetracycline

• Ciprofloxacin

How do these changes affect public health?

Infections caused by germs resistant to antibiotics — like gonorrhea — are a big public health problem. These types of infections can be harder to treat, and they may require more expensive medications and more follow-up doctor visits.

Here are some steps providers and public health officials are taking to fight gonorrhea antibiotic resistance:  

• Following the updated CDC guidelines for gonorrhea treatment

• Monitoring and reporting on antibiotic-resistant gonorrhea strains

• Continuing to research and develop new treatments

One of the most important steps you can take to fight antibiotic resistance is to take any antibiotics you’re given exactly as prescribed. This means not skipping any doses and completing the whole course, even if you feel better before finishing the whole course.  

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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