Gonorrhea and Chlamydia

  • Insertive and receptive oral sex
  • Insertive and receptive anal sex
Anatomic sites of infection and/or colonization
  • Urethra
  • Pharynx
  • Rectum
  • Urethritis: dysuria, clear to purulent urethral discharge
  • Rectum: usually asymptomatic ( May cause anal discomfort, tenesmus, mucopurulent discharge )
  • Pharynx: asymptomatic
Testing. In most jurisdictions, testing is by nucleic acid amplification (NAAT). Urethra: collect first voided urine (20-60mL), not midstream Rectum: swab. First moisten the swab with tap water. Then insert 4 cm into the rectum. Pharynx: swab. Swab the entire posterior pharynx. Treatment
  • Gonorrhea
    • PHAC Guideline – Ceftriaxone 250 mg IM PLUS Azithromycin 1g PO
    • CDC Guideline – Ceftriaxone 500 mg IM alone
    • Alternate – Cefixime 800mg PO
  • Chlamydia
    • Urethra and pharyngeal – Azithromycin 1g PO
    • Proctitis – Doxycycline 100 mg BID for 7 days