## First-Line Treatment of Gonorrhea **Key Point:** Ceftriaxone 250 mg IM as a single dose is the current gold-standard first-line treatment for uncomplicated urogenital gonorrhea, recommended by CDC, WHO, and Indian STI guidelines. ### Rationale for Ceftriaxone **High-Yield:** Ceftriaxone is preferred because: 1. Excellent tissue penetration and bactericidal activity against *Neisseria gonorrhoeae* 2. Single-dose regimen ensures compliance 3. Effective against both susceptible and moderately resistant strains 4. Minimal side effects 5. No significant drug interactions ### Treatment Algorithm ```mermaid flowchart TD A[Urethral discharge + Gram-negative diplococci]:::outcome --> B{Gonorrhea confirmed?}:::decision B -->|Yes| C[Ceftriaxone 250 mg IM single dose]:::action C --> D[Add azithromycin 1 g single dose<br/>for possible co-infection]:::action D --> E[Test of cure at 1 week<br/>if symptoms persist]:::outcome B -->|No| F[Consider Chlamydia/other STI]:::outcome ``` **Clinical Pearl:** Always co-treat with azithromycin 1 g single dose or doxycycline 100 mg BD × 7 days to cover concurrent *Chlamydia trachomatis* infection, which occurs in 30–50% of gonorrhea cases. ### Why Ceftriaxone Over Alternatives | Feature | Ceftriaxone | Ciprofloxacin | Doxycycline | Spectinomycin | |---------|-------------|---------------|-------------|---------------| | **Resistance** | Low | High (>50% in many regions) | Not primary agent | Rare but expensive | | **Dosing** | Single IM dose | 7-day course | 7-day course | Single IM dose | | **Efficacy** | >99% | <80% (outdated) | Not monotherapy | >95% | | **Compliance** | Excellent | Moderate | Moderate | Good | | **Cost** | Moderate | Low | Low | High | **Warning:** Fluoroquinolones (ciprofloxacin, ofloxacin) are NO LONGER recommended due to widespread resistance globally and in India. Do not use for gonorrhea. [cite:Park 26e Ch 8]
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