Scope of this summary
Adolescents and adults with suspected or confirmed uncomplicated urogenital, rectal or pharyngeal gonorrhea. Pelvic inflammatory disease, epididymitis, disseminated infection, neonatal or pediatric disease and sexual assault require linked CDC pathways.
The Bottom Line
- Test every exposed anatomic site with an FDA-cleared nucleic-acid amplification test; a urine or genital test does not exclude pharyngeal or rectal infection.
- For uncomplicated cervical, urethral or rectal gonorrhea, CDC recommends ceftriaxone 500 mg intramuscularly once when weight is under 150 kg and 1 g once at 150 kg or above.
- If chlamydia has not been excluded, add doxycycline 100 mg orally twice daily for seven days, using the pregnancy-specific chlamydia alternative when applicable.
- Obtain culture and antimicrobial susceptibility testing when treatment failure is suspected, because NAAT cannot provide susceptibility and resistant gonorrhea is an urgent public-health concern.
- Retest for reinfection at three months, ensure recent partners are evaluated and treated, and offer testing for chlamydia, syphilis and HIV plus HIV PrEP when appropriate.
Practical clinical workflow
1
Take an inclusive sexual history covering sites of exposure, symptoms, pregnancy, allergy, prior antibiotics, travel, partners and assault; assess for pelvic, testicular, systemic, joint or skin findings.
2
Collect NAAT from all exposed sites and culture before treatment when resistance or failure is possible; do not delay treatment for a symptomatic or high-risk patient when follow-up is uncertain.
3
Give weight-based ceftriaxone and add chlamydia therapy when not excluded, document the injection, and counsel no sex for seven days after treatment and until all partners are treated.
4
Perform a test of cure seven to fourteen days after pharyngeal gonorrhea using culture or NAAT; culture a positive NAAT where possible before retreatment and obtain susceptibility.
5
Retest every treated patient at three months and arrange partner services or expedited partner therapy where clinically appropriate and legally permitted, with special caution for partners who may have pelvic inflammatory disease.
Safety boundaries and escalation
- Fever, rash, tenosynovitis, migratory polyarthralgia, septic arthritis, meningitic symptoms or endocarditis features suggests disseminated gonococcal infection and requires culture, hospital or specialist assessment and parenteral therapy.
- Severe pelvic or lower-abdominal pain, pregnancy, vomiting, tubo-ovarian abscess concern or inability to exclude a surgical emergency requires the pelvic-inflammatory-disease acute pathway.
- Persistent symptoms three to five days after recommended treatment without re-exposure should trigger culture, susceptibility testing and immediate health-department or CDC consultation before empiric serial antibiotics.
- Pharyngeal infection is harder to eradicate and is an important resistance reservoir; do not omit site-specific test of cure or assume a negative genital result covers it.
Localization
The CDC regimen reflects US resistance surveillance and available formulations. State expedited-partner-therapy law, reporting and health-department culture access vary.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Centers for Disease Control and PreventionSexually Transmitted Infections Treatment Guidelines, 2021MMWR Recomm Rep 2021;70(No. RR-4):1–187 · Current CDC STI treatment guideline portal, including published erratum and 2026 supply notices · published 2021-07-23 · accessed 2026-08-20view source
- Centers for Disease Control and PreventionClinical Treatment of GonorrheaCurrent clinical-care page linked to the 2021 CDC STI Treatment Guidelines · accessed 2026-08-20view source
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