## Drug of Choice for Uncomplicated Urogenital Gonorrhea **Key Point:** Ceftriaxone 250 mg IM as a single dose is the current gold-standard first-line treatment for uncomplicated urogenital gonorrhea worldwide, including in India. ### Rationale for Ceftriaxone 1. **Efficacy**: Achieves >99% cure rate for uncomplicated urethritis and cervicitis 2. **Resistance pattern**: Remains effective despite widespread penicillin and fluoroquinolone resistance in N. gonorrhoeae 3. **Pharmacokinetics**: Single IM dose achieves high urethral and cervical concentrations 4. **WHO recommendation**: Listed as preferred agent in current treatment guidelines ### Why Ceftriaxone Over Alternatives | Feature | Ceftriaxone | Penicillin | Tetracycline | Ciprofloxacin | |---------|-------------|-----------|--------------|---------------| | **Resistance** | Rare | High (>50%) | Moderate | High (>50%) | | **Dosing** | Single IM | Multiple doses | 7-day course | 3-day course | | **Efficacy** | >99% | <50% | ~90% | <90% | | **Status** | Current DOC | Obsolete | Suboptimal | Obsolete | **High-Yield:** Penicillin resistance in N. gonorrhoeae emerged in the 1970s–80s and is now >50% globally. Fluoroquinolone resistance is also widespread. Cephalosporin resistance remains rare but is being monitored. **Clinical Pearl:** Uncomplicated gonorrhea in men typically presents with acute urethritis (dysuria, purulent discharge) within 2–7 days of exposure. In women, cervicitis may be asymptomatic in up to 50% of cases, increasing risk of ascending infection (PID, salpingitis). **Warning:** Do NOT use penicillin, tetracycline, or fluoroquinolones as monotherapy for gonorrhea in current practice—resistance rates are unacceptably high. Ceftriaxone is non-negotiable for first-line treatment. [cite:Harrison 21e Ch 137]
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