Infectious diseases
Gonorrhea: match the dose, site and follow-up
The medicine can be right while the dose and follow-up are wrong. Read weight, anatomic site and chlamydia status before deciding how an uncomplicated gonorrhea case should be managed. Cure and reinfection checks answer different questions.
Sources checked October 7, 2026. Independent educational content, not NABP exam questions or individual treatment advice.
Use the boundary exactly
The adult and adolescent uncomplicated cervical, urethral or rectal regimen is ceftriaxone 500 mg IM once below 150 kg. At 150 kg or above it is 1 g IM once. The pharyngeal regimen uses the same weight boundary. Exactly 150 kg belongs in the higher-dose branch.
This is not a universal regimen for neonatal or disseminated infection. Joint symptoms, severe allergy and other complications need the appropriate full guidance. First identify whether the case is actually uncomplicated before applying the simple branch.
Do not revive routine dual therapy
For uncomplicated cervical, urethral or rectal infection, CDC adds doxycycline 100 mg orally twice daily for 7 days if chlamydia has not been excluded. This is not routine azithromycin co-treatment for every gonorrhea case. Pregnancy requires its own chlamydia regimen.
The pharyngeal section says to treat chlamydia when it is identified during testing. Read the site-specific wording and results, and preserve the actual sites assessed. A negative result at one site is not proof that every exposure site was tested.
Separate cure from reinfection
Uncomplicated urogenital or rectal infection treated with a recommended or alternative regimen does not routinely need a test of cure. Pharyngeal infection does, using culture or NAAT at 7 to 14 days. Testing at 7 days may increase false-positive results.
Retesting at 3 months detects repeat infection regardless of perceived partner treatment. That later test does not replace the pharyngeal test of cure. Put the purpose next to each appointment so the two tasks do not collapse into one vague follow-up instruction.
Check transmission and apparent failure
CDC advises abstaining from sexual activity for 7 days after treatment and until partners are treated, with symptom resolution where relevant. Partner care, other STI testing and appropriate HIV prevention remain part of the plan after a correct dose is given.
Persistent symptoms need evaluation. Suspected treatment failure requires culture and susceptibility testing because NAAT cannot report susceptibility. Recover subsequent exposures and partner treatment before labeling every later positive result ceftriaxone resistance; reinfection is common.
A worked case
A nonpregnant 150 kg adult has uncomplicated pharyngeal gonorrhea, negative chlamydia testing and no severe beta-lactam allergy. The plan specifies ceftriaxone 500 mg once and testing only at three months. Find two mismatches.
- At exactly 150 kg, the cited dose is ceftriaxone 1 g IM once.
- Pharyngeal infection needs a 7-to-14-day test of cure.
- Keep the three-month reinfection retest and partner counseling as separate steps.
Answer: The dose boundary and pharyngeal test-of-cure timing need correction.
Try it before reading the answer
Write the key fact, decision and safety check first. These are original practice exercises, not recalled exam items.
1. A 149 kg adult has uncomplicated rectal infection. What is the cited ceftriaxone dose?
500 mg IM once. Chlamydia status, allergy and clinical context still need checking.
2. Does three-month retesting replace the pharyngeal test of cure?
No. They serve different purposes.
3. Can NAAT establish antibiotic susceptibility?
No. Suspected failure requires culture and susceptibility testing.
Continue learning
Put the topic into a study planSources and scope
Source dates and limits matter. Follow the current official source for clinical or regulatory decisions. Examples are simplified teaching cases, not prescribing, diagnostic or compounding instructions. Check the full current guidance and individual clinical context.