The Management of Gonorrhea in the Era of Emerging Antimicrobial Resistance What Primary Care Clinicians Should Know

Gonorrhea rates continue to rise in the US and different populations disproportionally carry the burden of disease. Complicating the management is N. gonorrhoeae's propensity to develop resistance to all therapies that have been used for gonococcal treatment. As antimicrobial resistance increases in the US, there are few new antimicrobials being developed. Ceftriaxone is the last remaining highly effective singledose recommended regimen for gonococcal treatment. The 2021 CDC STI Treatment Guidelines increased the dose of ceftriaxone to 500 mg (1 g if > 150 kg) for uncomplicated infections. An increasing number of ceftriaxone-based treatment failures have been reported internationally, most commonly at the pharynx. Therefore, all pharyngeal gonococcal infections are recommended to undergo TOC 7 to 14 days after treatment. It is recommended that all providers, laboratorians, and public health staff become aware of antimicrobial resistant gonorrhea and be able to identify, appropriately manage, and report any suspected gonorrhea treatment failure case.