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Gonorrhoea - Management
How should I manage a person with gonorrhoea in primary care?

  • Ideally, refer all people with confirmed or suspected gonorrhoea to a genito-urinary medicine clinic or to a general practice providing an enhanced sexual health service.
  • If these services cannot be accessed within a reasonable time, or if the person is unwilling to attend despite receiving appropriate information and advice:
    • For confirmed anogenital gonorrhoea, treat with a cephalosporin (cefixime or ceftriaxone) first line. A fluoroquinolone (ciprofloxacin or ofloxacin) may be a suitable alternative only if the organism is known to be sensitive to it.
    • For confirmed pharyngeal gonorrhoea, treat with ceftriaxone first line if it is available; otherwise, consider a 3-day course of cefixime. Ciprofloxacin may be a suitable alternative only if the organism is known to be sensitive to it.
    • If gonorrhoea has not been confirmed, treat empirically whilst waiting for laboratory confirmation, and consider offering an antibiotic to cover Chlamydia trachomatis (azithromycin or doxycyline).
    • For women who are pregnant or breastfeeding, who have confirmed or suspected gonorrhoea:
      • Treat with a cephalosporin (cefixime or ceftriaxone). Fluoroquinolones (ciprofloxacin or ofloxacin) are not recommended.
      • If an antibiotic to cover infection with C. trachomatis is also required, treat with amoxicillin, erythromycin, or azithromycin. Doxycycline is contraindicated.
    • Offer screening for other STIs and for HIV.
    • Encourage patient-led partner notification.
      • Partners should be screened for sexually transmitted infections and treated empirically for gonorrhoea whilst awaiting results.
    • Follow-up after 1 week to verify the success of treatment.
      • Test of cure (swab for culture and sensitivity at least 3 days after antibiotic treatment) is required in pregnancy, for pharyngeal gonorrhoea, or if symptoms persist.
    • Advise the person to abstain from sex until they and any partners have successfully completed treatment, and to practice safe sex in the future.

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