Which antibiotic is the current first-line treatment for uncomplicated gonorrhoea in India as per latest STI guidelines?

Explanation

## Treatment of Uncomplicated Gonorrhoea **Key Point:** Ceftriaxone 250 mg as a single intramuscular injection is the current first-line therapy for uncomplicated gonorrhoea (urethritis, cervicitis, proctitis) in India and most developed countries, as per WHO and Indian STI guidelines. ### Rationale for Ceftriaxone 1. **Efficacy:** >99% cure rate for uncomplicated urogenital gonorrhoea 2. **Resistance pattern:** Fluoroquinolone-resistant N. gonorrhoeae (FRNG) is now widespread globally and in India; cephalosporins remain effective 3. **Penetration:** Excellent tissue and urethral penetration 4. **Single-dose regimen:** Improves compliance and reduces treatment failure **High-Yield:** Fluoroquinolones (ciprofloxacin, ofloxacin) are NO LONGER recommended due to widespread resistance. Penicillin is obsolete due to chromosomal and plasmid-mediated resistance. ### Recommended Regimen ```mermaid flowchart TD A[Uncomplicated Gonorrhoea]:::outcome --> B{Complication?}:::decision B -->|No| C[Ceftriaxone 250 mg IM single dose]:::action B -->|Yes - Disseminated| D[Ceftriaxone 1 g IV/IM Q12H × 7 days]:::action B -->|Yes - Meningitis| E[Ceftriaxone 1–2 g IV Q12H × 10–14 days]:::urgent C --> F[Add azithromycin 1 g PO single dose for chlamydia coverage]:::action D --> F F --> G[Counsel partner notification & treatment]:::action ``` ### Dual Therapy Recommendation **Clinical Pearl:** Current guidelines recommend ceftriaxone PLUS azithromycin (or doxycycline) to cover concurrent Chlamydia trachomatis and reduce selection of resistance. This is called syndromic management of urethritis/cervicitis. | Regimen | Indication | Cure Rate | |---------|-----------|----------| | Ceftriaxone 250 mg IM + Azithromycin 1 g PO | Uncomplicated gonorrhoea + presumed chlamydia | >98% | | Ceftriaxone 250 mg IM alone | Gonorrhoea only (chlamydia ruled out) | >99% | | Fluoroquinolone monotherapy | NOT recommended (high resistance) | <50% in India | | Penicillin | Obsolete (resistance >50%) | <20% | ### Why Other Options Are Wrong - **Penicillin:** Chromosomal and plasmid-mediated resistance widespread since 1980s–1990s - **Fluoroquinolones:** FRNG prevalence >50% in India; no longer first-line - **Tetracycline:** Inadequate cure rates; used only for chlamydia, not gonorrhoea monotherapy [cite:Park 26e Ch 11]