Bibliographic information
GuidelineUpdated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services.
Year of Publication2024
Issuing InstitutionWorld Health Organization
Recommendation
Updated
For adults and adolescents (including pregnant women) with genital, anorectal and/or oropharyngeal gonococcal infections, WHO suggests:
- ceftriaxone 1 g intramuscularly as a single dose.
If ceftriaxone is not available or refused, WHO suggests:
- cefixime 800 mg orally and performing test of cure.
If test of cure is not possible or when oropharyngeal infection is diagnosed or is a potential concern, WHO suggests:
- cefixime 800 mg orally plus azithromycin 2 g orally.
When resistance, allergy or availability of cephalosporins is a concern, WHO suggests one of the following options:
- spectinomycin 2 g intramuscularly as a single dose plus azithromycin 2 g
orally; or
- gentamicin 240 mg intramuscularly as a single dose plus azithromycin 2 g orally
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
Remarks
- Ceftriaxone 1 g intramuscularly may be painful; discuss with the individual theoption of using lidocaine as diluent with the injection.
- Azithromycin 2 g may cause gastrointestinal side-effects, especially on an emptystomach. To reduce side-effects, consider azithromycin 1 g taken at 6- to 12-hourintervals.
- Sexual abstinence, condom use and partner treatment should be discussed.
- WHO guidance on surveillance of antimicrobial resistance in N. gonorrhoeae andtest of cure is available.a
- Pregnant women should be closely monitored for adverse reactions (e.g. allergicreactions including anaphylactic shock, premature delivery and prematurerupture of membranes).