Gonococcal infections, including urethritis, cervicitis, epididymitis, and proctitis, are a significant cause of morbidity among sexually active men and women. The treatment of these sexually transmitted infections (STIs) has evolved over the years, mainly due to the emergence of antibiotic resistance.
Urogenital, anogenital, pharyngeal, and ocular gonococcal infections that are not associated with bacteremic or ascending spread of the pathogen to other organs are considered uncomplicated. This topic will address the treatment of these gonococcal infections, with a focus on urogenital infections. In 2012, the United States Centers for Disease Control and Prevention updated their guidelines on the treatment of Neisseria gonorrhoeae . The information in this topic is largely consistent with those guidelines, as well as the 2010 sexually transmitted disease (STD) treatment guidelines .
The clinical manifestations and diagnosis of gonorrhea are discussed elsewhere. The treatment of complicated infections, such as disseminated gonococcal infection and pelvic inflammatory disease, is found elsewhere. (See "Epidemiology, pathogenesis, and clinical manifestations of Neisseria gonorrhoeae infection" and "Cutaneous manifestations of gonorrhea" and "Diagnosis of gonococcal infections" and "Disseminated gonococcal infection" and "Treatment of pelvic inflammatory disease", section on 'Recommended regimens'.)
Therapeutic principles — It is desirable for a therapeutic gonococcal regimen to:
- Be highly effective at all anatomic sites of infection
- Be well tolerated (particularly in patients with recurrent infections)
- Offer the feasibility of single-dose therapy at the point of care