Gonorrhoea, Antibiotic Prescribing

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. 

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.


Comments from Expert Advisory Committee

  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).
  2. Infection 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. Infection can lead to epididymo-orchitis in males.
  4. Infection 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.
  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 currently give information on gonorrhoea antimicrobial susceptibility and wherever possible culture and sensitivity testing needs to be done. Treatment can be initiated, as outlined in the table below, without sensitivity results.
  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.
  12. Hepatitis C testing should be considered part of routine sexual health screening in the following circumstances: People who are HIV positive; Commercial sex workers; PWID People who inject drugs; If indicated by the clinical history e.g. unexplained jaundice; When other risk factors for HCV are present, for example MSM. The full set of recommendations around HCV testing are available in the national HCV screening guidelines
  13. Sexual partners in the preceding 6 months should be informed of the need for testing and patients should be encouraged to inform their sexual partners
  14. 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.

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

Gonorrhoea treatment table 2019 image

* this should be managed 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.Spectinomycin is difficult to source internationally. 

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