Sexual Health / HIV/Cephalosporin (STI)

Ceftriaxone (gonorrhoea)

also: gonorrhoea treatment · the clap · GC

Overview

First-line for gonorrhoea — ceftriaxone 1 g IM single-dose monotherapy (BASHH). The dose rise to 1 g and dropping azithromycin dual therapy are recent examinable changes.

Mechanism

Third-generation cephalosporin — binds penicillin-binding proteins → inhibits cell-wall peptidoglycan cross-linking → bactericidal against Neisseria gonorrhoeae.

Indications

Gonorrhoea (uncomplicated, incl. pharyngeal/rectal)
Disseminated gonococcal infection
Component of PID / epididymo-orchitis regimens

Adverse effects

Injection-site paincommon

Hypersensitivity (cross-reacts with penicillin)serious

C. difficile, diarrhoeacommon

Cautions & contraindications

Cephalosporin allergy / severe penicillin anaphylaxisall

Cross-reactivity — alternative regimen (cefixime+azithromycin) under specialist.

Interactions

Monitoring & kinetics

TEST OF CURE for all gonorrhoea (esp. pharyngeal); culture + sensitivities (resistance),Partner notification; full STI screen; abstain 7 days

1 g IM single dose. (If injection refused/CI: cefixime 400 mg PO + azithromycin 2 g PO — less effective.)

Choosing it

true

Source: BASHH 2019 — Gonorrhoea