Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

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

  • For confirmed anogenital gonorrhoea, prescribe:
    • A cephalosporin first line.
      • Cefixime (400 mg, single oral dose) is usually preferred owing to convenience (off-label indication).
      • Ceftriaxone (250 mg, intramuscular injection) is licensed but is often not readily available in primary care.
    • A fluoroquinolone is an alternative if cephalosporins are contraindicated (for example the person has a true allergy to penicillin-type antibiotics), provided that the infection is known to be sensitive to fluoroquinolones (that is, culture and sensitivity results are available for the person or recent sexual partners). Avoid fluoroquinolones in people with tendonitis or a history of epilepsy. Prescribe:
      • Ciprofloxacin (500 mg, single oral dose).
      • Ofloxacin (400 mg, single oral dose).
    • If both cephalosporins and fluoroquinolones are unsuitable, contact the local microbiology or genito-urinary medicine clinic for advice.
  • For confirmed pharyngeal gonorrhoea:
    • Administer ceftriaxone (250 mg, intramuscular injection) first line if this is available.
    • If ceftriaxone is unavailable, consider a 3-day course of oral cefixime (400 mg loading dose, followed by 200 mg twice a day for 3 days). Note this regimen is off label and is recommended on the basis of expert opinion rather than trial-based evidence.
    • Prescribe oral ciprofloxacin (if a cephalosporin is contraindicated) only if the infection is known to be sensitive to it.
  • For empirical treatment of suspected gonorrhoea (see Scenario: Diagnosis for clinical features), prescribe additional antibiotics to treat Chlamydia trachomatis.
    • Azithromycin (1 gram, single oral dose) or doxycycline (100 mg twice a day for 7 days) are suitable choices.
    • For more information, see the CKS topics on Urethritis - male and Vaginal discharge.

© NHS Institute for Innovation and Improvement