Based on summed data from clinical trials, monotherapy with azithromycin 1 g cures 97.6% of uncomplicated gonococcal infections of the urethra, cervix, or rectum (95% CI, 95.7%–98.9%), and monotherapy with azithromycin 2 g cures 99.2% of these infections (95% CI, 97.3%–99.9%) (Table 1) [ 14 ].
The recommended regimen for uncomplicated urethral, cervical, or rectal gonococcal infection is dual treatment with ceftriaxone 250 mg intramuscularly as a single dose and azithromycin 1 g orally as a single dose. Key Question 2.
However, because many infections are never diagnosed or reported, the true burden of gonococcal infection is likely significantly higher. It is estimated that >800 000 new gonococcal infections occur in the United States each year [ 3 ].
Gonococcal infections of the pharynx are more difficult to eradicate than infections of the urethra, cervix, or rectum [ 29 ], and few antimicrobial regimens reliably cure >90% of gonococcal pharyngeal infections (Table 6 ).
Issue Section: Gonorrhea, a sexually transmitted infection, is the second most commonly reported notifiable disease in the United States [ 1 ], with a total of 333 004 new cases reported to the Centers of Disease Control and Prevention (CDC) in 2013 [ 2 ].
Culture or NAAT can be used for test of cure. In practice, it is likely that NAATs will be used for test of cure in most settings. If a NAAT test of cure is positive, every effort should be made to obtain confirmatory culture before retreatment, and all positive test of cure cultures should undergo antimicrobial susceptibility testing.
In comparison, azithromycin 1 g as a single dose is generally associated with fewer and milder gastrointestinal symptoms, and studies using a 1-g dose report any adverse effect in <10% of patients [ 55, 56, 59 ].
The use of culture for test of cure facilitates antimicrobial susceptibility testing. However, the sensitivity of NAATs for detection of N. gonorrhoeae is superior to culture [ 78–84 ]. In practice, gonococcal culture is not readily available, and it is likely that NAATs will be used for test of cure in most settings.
Gonorrhea is the second most commonly reported notifiable disease in the United States and is associated with serious health sequelae, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Treatment for gonorrhea has been complicated by antimicrobial resistance.