Gonorrhoea is the second most common bacterial STI in England, with cases rising significantly in recent years. What makes gonorrhoea particularly concerning is the emergence of antibiotic-resistant strains, which has led to changes in how it is treated.
Current BASHH Treatment Guidelines
The British Association for Sexual Health and HIV (BASHH) recommends the following first-line treatment for uncomplicated gonorrhoea:
- Ceftriaxone 1 g intramuscular injection – administered as a single dose at a sexual health clinic
Previously, a combination of ceftriaxone and azithromycin was standard. However, following updated guidance and evidence around antimicrobial stewardship, azithromycin is no longer routinely co-prescribed unless there is a co-existing chlamydia infection.
Alternative Treatments
If ceftriaxone cannot be used (for example, due to severe allergy), alternatives may include:
- Ciprofloxacin 500 mg oral single dose — only if antimicrobial susceptibility testing confirms the strain is sensitive
- Gentamicin 240 mg IM plus azithromycin 2 g oral — used in specialist settings
Self-treatment with oral antibiotics alone is not recommended for gonorrhoea due to resistance concerns.
Why Is Gonorrhoea Hard to Treat?
Neisseria gonorrhoeae has developed resistance to nearly every class of antibiotic used against it historically, including penicillin, tetracyclines, and fluoroquinolones. The UK's Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) monitors resistance patterns nationally to inform treatment guidelines.
Test of Cure
Unlike chlamydia, a test of cure is recommended for all gonorrhoea cases. This should be performed at least 72 hours after treatment (for a NAAT) or after 2 weeks if using culture. This confirms the infection has been successfully cleared and helps detect treatment failures early.
Partner Notification
All sexual partners from the preceding 2 weeks (if symptomatic) or 3 months (if asymptomatic) should be contacted and offered testing and treatment. Your clinic can assist with anonymous partner notification if preferred.
Prevention
Consistent use of condoms significantly reduces the risk of gonorrhoea transmission. Regular screening, particularly for those with new or multiple partners, remains the best strategy for early detection and limiting the spread of resistant strains.