# Gonorrhoea (Uncomplicated Genital Infection) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: CDC STI Treatment Guidelines 2021 · WHO Guidelines for the Treatment of Neisseria gonorrhoeae 2016 · BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3 · CDC STI Treatment Guidelines 2021 (paediatric dosing) · Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903) - Verified date: 2026-08 ## Verified against - BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3 - CDC STI Treatment Guidelines 2021 (paediatric dosing) ## Treatment metadata - Ceftriaxone — 1000 mg — injection - Cefixime — 400 mg — oral.solid - Azithromycin — 500 mg — oral.solid - Gentamicin — injection - Doxycycline — 100 mg — oral.solid ## Complete treatment card ```text GONORRHOEA (UNCOMPLICATED GENITAL INFECTION) Sources: CDC STI Treatment Guidelines 2021 · WHO Guidelines for the Treatment of Neisseria gonorrhoeae 2016 · BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3 · CDC STI Treatment Guidelines 2021 (paediatric dosing) · Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (11) - As many as 90% of women with gonococcal cervicitis have no symptoms, so screening cannot rely on symptoms alone - Symptomatic gonococcal cervicitis can cause purulent vaginal discharge, painful urination, pelvic discomfort, or bleeding between periods [abdominal pain · abnormal uterine bleeding · burning on passing urine · pelvic pain · pus · vaginal discharge] - 56% to 87% of men with gonorrhea have no symptoms at all - Men who are symptomatic typically notice urethral discharge or pain on urination within 2 to 14 days of exposure [urethral discharge] - Untreated rectal gonorrhea can lead to rectal pain, bleeding, discharge, and proctitis [bleeding] - Disseminated infection, seen in about 0.5% to 3% of cases, causes fever, skin lesions, tendon inflammation, joint pain, and vasculitis [fever · joint pain · skin lesions] - It targets columnar and transitional epithelium, so the cervix, urethra, rectum, pharynx and conjunctiva are the sites it infects - The natural history runs from carriage with no complaints to urethritis, cervicitis or pelvic inflammatory disease - Left untreated it climbs to the uterus, the fallopian tubes and the ovaries, or spreads to what lies next to them, and the end of that road is infertility and ectopic pregnancy [infertility] - In men, an untreated infection goes on to epididymitis, prostatitis and urethral stricture [stricture] - Spread through the bloodstream happens in a minority and brings arthritis, tenosynovitis, rash, endocarditis and meningitis [rash] SIGNS - what you find (5) - Pelvic exam may show mucopurulent discharge from the cervix that bleeds easily when touched [bleeding tendency] - Bartholin gland involvement presents as labial swelling, abscess formation, and pain [abscess] - Male urethral discharge is thick and white, yellow, or green, and usually heavier than in chlamydia [urethral discharge] - Unilateral testicular pain and swelling on exam suggests epididymitis [testicular pain] - Disseminated arthritis usually affects one joint, most often the knee, though several joints can be involved TESTS (7) - A Gram stain of urethral discharge is about 99% specific in men, with about 95% sensitivity when symptomatic, dropping below 80% if asymptomatic - Gram stain sensitivity for endocervical swabs is much lower, only about 40% to 60% - Nucleic acid amplification testing is highly sensitive, over 95%, even in people without symptoms - Vulvovaginal swabs give more accurate results than endocervical swabs or urine testing - Culture is 85% to 95% sensitive for symptomatic urethral infection but only 50% to 70% sensitive when infection is asymptomatic or chronic - Point-of-care tests return results within 30 to 90 minutes with 97% to 100% sensitivity - Guidelines call for annual screening in sexually active women under 25, with repeat testing 3 months after treatment IF NOT THIS - what else fits (4) - Viral conjunctivitis is the most common cause of infectious pink eye, well more frequent than gonococcal conjunctivitis - Among children, bacterial forms of conjunctivitis - including the gonococcal type - occur more often than they do in adults - Lyme disease, meningococcemia, acute HIV infection, and reactive arthritis are diseases that can present similarly to disseminated gonococcal infection - Chlamydia, trichomoniasis, syphilis, Mycoplasma genitalium, and genital herpes can cause similar urogenital symptoms Source StatPearls "Gonorrhea" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Azithromycin + Gentamicin Rx: Main treatment | If severe cephalosporin allergy - with gentamicin | If severe cephalosporin allergy - with azithromycin | Co-treatment for chlamydia - given with the ceftriaxone MAIN TREATMENT - choose one 1. CEFTRIAXONE [1st line] Adult 1 g intramuscularly as a single dose. Reconstitute in 1% lidocaine - a 1 g IM injection is painful and that is a real reason people refuse it. If chlamydia has not been excluded, add doxycycline 100 mg twice daily for 7 days - Single dose Peds 25-50 mg/kg/dose [child max 250 mg] (Children under 45 kg: 25-50 mg/kg IM single dose, maximum 250 mg - not the adult 500 mg. Neonatal gonococcal ophthalmia requires emergency parenteral treatment under paediatric specialist care.) 3kg -> 75-150 mg/dose 4kg -> 100-200 mg/dose 5kg -> 125-250 mg/dose 6kg -> 150-250 mg/dose (upper capped) 7kg -> 175-250 mg/dose (upper capped) 8kg -> 200-250 mg/dose (upper capped) 9kg -> 225-250 mg/dose (upper capped) 10kg -> 250 mg/dose (capped) 11kg -> 250 mg/dose (capped) 12kg -> 250 mg/dose (capped) 13kg -> 250 mg/dose (capped) 14kg -> 250 mg/dose (capped) 15kg -> 250 mg/dose (capped) 16kg -> 250 mg/dose (capped) 17kg -> 250 mg/dose (capped) 18kg -> 250 mg/dose (capped) 19kg -> 250 mg/dose (capped) 20kg -> 250 mg/dose (capped) 21kg -> 250 mg/dose (capped) 22kg -> 250 mg/dose (capped) 23kg -> 250 mg/dose (capped) 24kg -> 250 mg/dose (capped) 25kg -> 250 mg/dose (capped) 26kg -> 250 mg/dose (capped) 27kg -> 250 mg/dose (capped) 28kg -> 250 mg/dose (capped) 29kg -> 250 mg/dose (capped) 30kg -> 250 mg/dose (capped) 31kg -> 250 mg/dose (capped) 32kg -> 250 mg/dose (capped) 33kg -> 250 mg/dose (capped) 34kg -> 250 mg/dose (capped) 35kg -> 250 mg/dose (capped) 36kg -> 250 mg/dose (capped) 37kg -> 250 mg/dose (capped) 38kg -> 250 mg/dose (capped) 39kg -> 250 mg/dose (capped) 40kg -> 250 mg/dose (capped) 41kg -> 250 mg/dose (capped) 42kg -> 250 mg/dose (capped) 43kg -> 250 mg/dose (capped) 44kg -> 250 mg/dose (capped) 45kg -> 250 mg/dose (capped) This mg/kg figure applies up to 45 kg only - above that, dose on specialist advice AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3 Why BASHH raised this from 500 mg to 1 g. Ceftriaxone still works - most infections with reduced susceptibility are still cleared at 1 g, and the few reported failures have been pharyngeal. Egypt sells 39 different 1 g vials and the cheapest is 22 EGP, so the higher dose costs almost nothing here. Caution Perform test-of-cure 14 days after treatment if symptoms persist or if pharyngeal gonorrhoea is suspected. Treat all sexual partners from the past 60 days. Screen for co-existing STIs including Chlamydia trachomatis, HIV, and syphilis. The paediatric figures here are CDC's, not BASHH's - the BASHH guideline is written for people aged 16 and over. Egypt ZOXIDEL 1 GM PD. FOR I.M. INJ. RAMEDA > DELT... 22.00 EGP CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA) KAHIRA 29.00 EGP ZOXIDEL 1 GM PD. FOR I.V. INJ. RAMEDA > DELT... 29.00 EGP WINTRIAXONE 1 GM PD. FOR I.V INJ. SANOFI 48.00 EGP VOTRIAXONE 1 GM I.M VIAL CHEMIPHARM 56.00 EGP OFRAMAX 1 GM I.M. VIAL RAMEDA > SUN ... 71.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP 2. CEFIXIME [2nd line] Adult 400 mg orally, then a second 400 mg 6-12 hours later, PLUS azithromycin 2 g orally as a single dose (or 1 g then another 1 g 6-12 hours later, which is easier on the stomach). Add doxycycline 100 mg twice daily for 7 days if chlamydia is not excluded - two cefixime doses 6-12 hours apart, on one day Peds 8 mg/kg/dose [child max 400 mg] (Children <45 kg: 8 mg/kg single oral dose (max 400 mg). Specialist pediatric consultation required.) 3kg -> 24 mg/dose 4kg -> 32 mg/dose 5kg -> 40 mg/dose 6kg -> 48 mg/dose 7kg -> 56 mg/dose 8kg -> 64 mg/dose 9kg -> 72 mg/dose 10kg -> 80 mg/dose 11kg -> 88 mg/dose 12kg -> 96 mg/dose 13kg -> 104 mg/dose 14kg -> 112 mg/dose 15kg -> 120 mg/dose 16kg -> 128 mg/dose 17kg -> 136 mg/dose 18kg -> 144 mg/dose 19kg -> 152 mg/dose 20kg -> 160 mg/dose 21kg -> 168 mg/dose 22kg -> 176 mg/dose 23kg -> 184 mg/dose 24kg -> 192 mg/dose 25kg -> 200 mg/dose 26kg -> 208 mg/dose 27kg -> 216 mg/dose 28kg -> 224 mg/dose 29kg -> 232 mg/dose 30kg -> 240 mg/dose 31kg -> 248 mg/dose 32kg -> 256 mg/dose 33kg -> 264 mg/dose 34kg -> 272 mg/dose 35kg -> 280 mg/dose 36kg -> 288 mg/dose 37kg -> 296 mg/dose 38kg -> 304 mg/dose 39kg -> 312 mg/dose 40kg -> 320 mg/dose 41kg -> 328 mg/dose 42kg -> 336 mg/dose 43kg -> 344 mg/dose 44kg -> 352 mg/dose 45kg -> 360 mg/dose 46kg -> 368 mg/dose 47kg -> 376 mg/dose 48kg -> 384 mg/dose 49kg -> 392 mg/dose 50kg -> 400 mg/dose AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source BASHH UK National Guideline for the Management of Infection with Neisseria gonorrhoeae, 2025, sections 11.2 and 11.3 Why Only when an intramuscular injection is genuinely contraindicated AND susceptibility results are in hand. The single 800 mg dose is gone: BASHH split it into two 400 mg doses because what clears the organism is the time the free drug stays above the MIC, not the peak - and a second dose achieves that where a bigger single one does not. Caution Give the second cefixime dose 6-8 hours after the first, and no later than 12. Past 12 hours there is no benefit in taking it, and no benefit in restarting. Never cefixime alone for pharyngeal infection - it has failed as monotherapy there, which is why the azithromycin is not optional. Cure rates are lower for pharyngeal gonococcal infection compared to IM ceftriaxone; test-of-cure is mandatory. Contraindicated in patients with severe cephalosporin or anaphylactic penicillin allergy. Egypt HEBIXIME 400MG 5 CAPS. SHIFA MEDICAL... 60.00 EGP (12.00/unit) XIMACEF 400MG 5 CAPSULE SIGMA 63.00 EGP (12.60/unit) WIDEPREX 400 MG 5 CAPS. BIOMED PHARMA... 104.00 EGP (20.80/unit) SUPRAX 400 MG 5 CAPS. KAHIRA > HIKM... 159.00 EGP (31.80/unit) VIODRILNEX 100MG/5ML SUSP. 30ML BADR PHARMA >... 21.50 EGP -> ? strength differs, ? different route - not oral solid CEFABRUM 100MG/5ML SUSP. 60ML ALFACURE PHAR... 27.00 EGP -> ? strength differs, ? different route - not oral solid IF SEVERE CEPHALOSPORIN ALLERGY - WITH GENTAMICIN 3. AZITHROMYCIN [1 of 2 - GIVE ALL TOGETHER] Adult 2 g by mouth as a single dose, taken with the gentamicin injection - single dose Peds No paediatric dose for this regimen in the sources opened. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903) Why The second half of the fallback regimen for the patient who cannot have a cephalosporin; neither drug clears gonorrhoea reliably on its own at these doses. Caution Given only together with the gentamicin injection, as one treatment. Azithromycin can prolong the QT interval; take care in cardiac disease or with other QT- prolonging drugs. Arrange a test of cure, because this is a fallback regimen rather than the recommended one. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid IF SEVERE CEPHALOSPORIN ALLERGY - WITH AZITHROMYCIN 4. GENTAMICIN [2 of 2 - GIVE ALL TOGETHER] Adult 240 mg as a single intramuscular dose, given together with azithromycin 2 g orally as a single dose - single dose Peds No paediatric dose for this regimen in the sources opened. Source Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903) Why Ceftriaxone and cefixime are both cephalosporins, so the patient with a severe cephalosporin allergy needs another route. This is the one the article gives for that patient, and it is one injection given in the clinic rather than a hospital regimen. Caution The gentamicin is never given on its own here - the oral azithromycin is part of the same single treatment and one without the other will not clear the infection. Egyptian gentamicin ampoules are smaller than this dose, so it has to be made up from more than one ampoule. Avoid in significant renal impairment and in anyone with known aminoglycoside hearing loss. Only use this route when the cephalosporin allergy is genuinely severe; a vague penicillin history is not a reason to leave ceftriaxone behind. Arrange a test of cure, because this is a fallback regimen rather than the recommended one. Egypt REFOBACIN 40MG 3 AMP. GLAXO SMITHKL... 6.00 EGP REFOBACIN 80MG 3 AMP. GLAXO SMITHKL... 9.00 EGP GENTAMICIN-ALEX 20MG/2ML 6 AMP. ALEXANDRIA 12.00 EGP EPIGENT 20MG/2ML I.V./I.M. 3 AMPS. EIPICO 24.00 EGP GENTAMICIN-ALEX 80MG/2ML 3 AMP. I.M/I.V INJ. ALEXANDRIA 52.50 EGP EPIGENT 80MG/2ML I.M./I.V. 3 AMPS. EIPICO 54.00 EGP GARAMYCIN 20MG/2ML 6 AMPS. MEMPHIS 66.00 EGP GARAMYCIN 40MG/ML 6 AMPS. MEMPHIS 72.00 EGP CO-TREATMENT FOR CHLAMYDIA - GIVEN WITH THE CEFTRIAXONE - give alongside 5. DOXYCYCLINE [add-on - not a substitute] Adult 100 mg twice a day x 7 days Peds No paediatric dose for this co-treatment in the sources opened. Source Gonorrhea - StatPearls - NCBI Bookshelf (NBK558903) Why Gonorrhoea and chlamydia are caught together often enough that the article treats both unless chlamydia has been ruled out by a test. Covering only the gonococcus leaves the second half of the standard visit undone. Caution Do not give this in pregnancy - the article substitutes a single oral dose of azithromycin. Skip it only if a chlamydia test has actually come back negative, not because the patient looks low risk. Warn about sun sensitivity, and have the capsule taken upright with plenty of water so it does not lodge in the gullet. Treat the sexual partner as well, or the patient is reinfected. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)