Gonorrhoea

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or the printed Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide.

Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.


General Information

  1. The number of cases of gonorrhoea reported in Ireland has been increasing in the recent past and the increase appears to be occurring in young heterosexual men and women and men who have sex with men (MSM), particularly HIV positive MSM
  2. Can be asymptomatic in both males and females. Symptoms in males include dysuria and a urethral discharge. Symptoms in women include vaginal discharge, intermenstrual bleeding, post coital bleeding
  3. Can lead to epidydmorchitis in males.
  4. Can lead to pelvic inflammatory disease (PID) in females. PID is associated with an increased risk of tubal factor infertility, ectopic pregnancy and chronic pelvic pain
  5. Diagnosis using NAAT (nucleic acid amplification technique, eg PCR, polymerase chain reaction) is the current diagnostic gold standard. This is frequently combined with a chlamydia NAAT in the same test
  6. Diagnosis can be made on first void urine in males and vulvovaginal or endocervical swab in females. Vulvovaginal swabs can be provider or self-taken, further information on this is available in the ICGP STI e learning module
  7. In sexually active men who have sex with men (MSM), depending on sexual exposure, pharyngeal and rectal sites should be tested too.
  8. Increasing resistance to antimicrobials is a major concern with gonorrhoea globally.
  9. NAAT testing does not give information on gonorrhoea antimicrobial susceptibility and wherever possible culture and sensitivity testing needs to be done.
  10. Test of cure is recommended 2-3 weeks post completion of treatment.
  11. Individuals diagnosed with gonorrhoea should be offered testing for other STIs including HIV, Hepatitis B, syphilis and chlamydia. Hepatitis C testing should be offered to those with a history of injecting drug use and MSM, further information on this is available in the ICGP STI e-learning module
  12. Gonorrhoea is a notifiable disease. The complete list of notifiable diseases and information on the notification process is available from the HPSC.

Treatment

See guidance on dosing in children for quick reference dosage/weight guide

Empiric treatment with oral cefixime is inappropriate.

Treatment of uncomplicated angogenital and pharyngeal gonorrhoea in adults including those with cephalosporin allergy.

Uncomplicated angogenital and pharyngeal gonorrhoea in adults (1st linef for cervical, pharyngeal, rectal and urethral gonerrhoea)

Uncomplicated angogenital and pharyngeal gonorrhoea in adults with cephalosporin allergy*

OR

previous or immediate and/or severe hypersensitivity to penicillin or other Β-lactam*

Pharngeal gonorrhoea+ in adults with cephalosporin allergy*

OR

previous or immediate and/or severe hypersensitivity to penicillin or other Β-lactam*

Ceftriaxone 500mg IM stat

AND

Azithromycin 1g PO stat

Ciprofloxicin 500mg PO stat (when known to be quinolone sensitive)

OR

Spectinomycin 2g deep IM stat

OR

Azithromycin 2g PO stat (when known to be susceptible to Azithromycin)

Ciprofloxicin 500mg PO stat (when known to be sensitive to quinolones)++

OR

Azithromycin 2g PO stat (when known to be susceptible to Azithromycin)

* this should be administered in a specialist setting and if not feasible, only following specialist advice, especially where sensitivity of the isolate is not known and a symptomatic person is being treated empirically.
+ Single dose treatment with Spectinomycin has poor efficacy in treatment of gonococcal infection of the pharynx.
++ In practice additional doses of Ciprofloxicin are generally given in this situation because of poor penetration of Ciprofloxicin into the pharynx. 

Useful Resources


Patient Information

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

Reviewed June 2017


antibiotics banner