Gonorrhoea

• Contact tracing (screening) and treatment of partners is crucial. Refer to Sexual Health.
• Azithromycin is to cover for chlamydia which co-exists with gonorrhoea in 40–50% of cases.
• Do not use a single drug. Multidrug use is to minimise the risk of emerging resistance.
• See also local Pelvic Inflammatory Disease (PID) guidelines.

Pathogens

• N. gonorrhoeae ± organisms associated with pelvic inflammatory disease

Drug Treatment

• Duration: See dose below.

Empiric

Urethritis/cervicitis/pharyngeal and rectal gonorrhoea

ceftriaxone HMLSchedNZFPMLnoids Ceftriaxone F: n/a Half life: 8 hours Elimination: 50% renal and 50% biliary excretion fe: 0.5

IM 500 mg stat

AND

azithromycin HMLSchedNZFPML Azithromycin F: 0.4 Half life: 60 hours Elimination: substantial biliary excretion fe: 0.1 Additional points: ↑ warfarin effect.

PO 1000 mg stat

Severe penicillin allergy

Consult with specialist and give:

If known to be sensitive to ciprofloxacin:

ciprofloxacin HMLSchedNZFPMLnoids Ciprofloxacin F: 0.7 Half life: 4 hours Elimination: renal fe: 0.5 Additional points: Inhibits CYP1A2 and 3A. Antacids, milk, and enteral feeds ↓ absorption.

PO 500 mg stat

• Inhibits CYP1A2 (strong) and 3A.
• Subject to OAT and OATP (transporter) inhibition.
• Avoid in pregnancy and breastfeeding.

AND

Disseminated disease

• Consult Infectious Diseases/Sexual Health.

Pelvic inflammatory disease/epididymitis co-exist and may require IV therapy.

Topic Code: 99254

must be prescribed or recommended by a consultant.