Syphilis and Gonorrhea

Syphilis and Gonorrhea Increase in Orange County

Along with many other health jurisdictions in California we are seeing an increase this year in cases of gonorrhea and early syphilis in Orange County.

To assist you in the diagnosis and treatment of these diseases please refer to the "Updated Gonorrhea Treatment Recommendations" below and the link to very useful algorithms on "Evaluating Patients for Primary and Secondary Syphilis."

If you have any questions on STD treatment, please feel free to call HIV/STD Services, County of Orange Health Care Agency, at (714) 834-8598.

Updated Gonorrhea Treatment Recommendations

In the August 10, 2012 Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) updated its Sexually Transmitted Treatment Guidelines for gonorrhea treatment:

  1. Dual antibiotic treatment with ceftriaxone 250mg IM plus azithromycin 1 g orally (or doxycycline 100mg orally twice a day for 7 days) is now the ONLY recommended treatment regimen for uncomplicated urogenital, anorectal and pharyngeal gonorrhea.
  2. The oral cephalosporin cefixime is no longer a recommended therapy. It can be used as an alternative with azithromycin or doxycycline if ceftriaxone is not available.
  3. Fluoroquinolones are not recommended for gonorrhea due to high levels of resistance.
  4. Other oral cephalosporins, including cefuroxime and cefpodoxime are no longer considered alternative treatment regimens.
  5. For cephalosporin-allergic patients, azithromycin 2 grams orally may be used as an alternative regimen.
  6. Dual antibiotic treatment should be given regardless of any chlamydia test result.

Recommendations for Tests-of Cure (TOC) with Gonorrhea

Test-of Cure is recommended for:

  1. All pregnant women diagnosed with gonorrhea
  2. Cases of suspected treatment failure
  3. Men who have sex with men (MSM) who have been treated with an alternative regimen

TOC should be performed using culture. NAAT testing is an acceptable second choice. But, if the NAAT is positive a confirmatory culture should be done with antimicrobial susceptibility testing.

If you do not have access to gonorrhea culture and susceptibility testing, please call the Orange County Public Health Department at (714) 834-8598.

Suspected Cephalosporin Treatment Failure with Gonorrhea

For patients with suspected treatment failure after dual therapy with ceftriaxone or cefixime plus azithromycin or doxycycline, the Orange County Public Health Department at (714) 834-8598.

Evaluating Patients for Primary and Secondary Syphilis

Please follow this link to the County’s 17th Street Testing, Treatment and Care (STD/HIV Clinics) webpage:

Click on "Links" on the left side of the page to get to "Provider Information."

You will find two very useful pdf documents on "Evaluating Patients for Primary Syphilis" and "Evaluating Patients for Secondary Syphilis."

The CDC STD Treatment guidelines can be found at this link:

Feel free to forward this information to your colleagues or other interested health care providers.

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