## First-Line Treatment of Uncomplicated 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. **High efficacy** — >99% cure rate for uncomplicated urogenital gonorrhea 2. **Excellent tissue penetration** — achieves high concentrations in urethra and cervix 3. **Resistance profile** — remains effective despite widespread fluoroquinolone and penicillin resistance in *Neisseria gonorrhoeae* 4. **Single-dose convenience** — improves compliance 5. **Minimal side effects** — well tolerated in most patients ### Why Other Agents Are No Longer First-Line | Drug | Reason for Discontinuation | |------|----------------------------| | **Ciprofloxacin** | Widespread fluoroquinolone-resistant *N. gonorrhoeae* (QRNG); no longer recommended by CDC/WHO since 2007 | | **Penicillin G** | Penicillinase-producing *N. gonorrhoeae* (PPNG) and chromosomally resistant strains are endemic; efficacy <50% | | **Doxycycline** | Used for chlamydia co-infection, NOT for gonorrhea monotherapy; resistance emerging | **Clinical Pearl:** In India, ceftriaxone 250 mg IM remains the standard of care per NACO (National AIDS Control Organization) and ISSTD guidelines, though some centres now use 500 mg for enhanced efficacy in high-resistance settings. **Warning:** Do NOT use fluoroquinolones (ciprofloxacin, ofloxacin) for gonorrhea in routine practice — resistance rates exceed 50% in many regions. ### Concurrent Chlamydia Coverage If chlamydia co-infection is suspected or confirmed, add **azithromycin 1 g orally single dose** or **doxycycline 100 mg BD × 7 days** after excluding pregnancy.
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