The CDC has updated its recommendation for the treatment of uncomplicated gonorrhea in adults. Gonorrhea should now be treated with just one higher dose (500 mg) injection of ceftriaxone, and dual therapy is no longer the recommended approach.
Treat gonorrhea infections with a single 500 mg injection of ceftriaxone.
A test-of-cure is not needed for people who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea unless symptoms persist.
A test-of-cure is recommended in people with pharyngeal gonorrhea 7-14 days after the initial treatment, regardless of the regimen.
Patients who have been treated for gonorrhea should be retested three months after treatment to ensure there is no reinfection.
As always, facilitate partner testing and treatment.
This essentially eliminates the option for Zithromax 1000mg single dose for coverage of Gonorrhea and Chlamydia. We need to administer the higher dose of Rocephin (was previously 250mg) to cover for Gonorrhea.
Rocephin alone does not cover Chlamydia. Additional coverage is necessary if chlamydia is suspected. Current CDC recommendations for treatment of Chlamydia are:
Recommended Regimens
Azithromycin 1 g orally in a single dose OR
Doxycycline 100 mg orally twice a day for 7 days
Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7 days OR
Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR
Levofloxacin 500 mg orally once daily for 7 days OR
Ofloxacin 300 mg orally twice a day for 7 days
TL;DR - Treat STD with Rocephin 500mg IM x1 and either Zithromax 1000mg x1 or Doxy 100mg PO BID x 7 days