[Question #2905] Gonorrhea treatment

42 months ago
Hi doctors. I went for my yearly physical yesterday and told my doctor that I occasionally feel discomfort while peeing so he decided to treat me for gonorrhea and chlamydia he said the treatment is a injection of Ceftriaxone and  azithromcyin orally since I have a phobia of shots he prescribed Cefixime and azithromcyin but he told me it's not the first line treatment it's an alternative. When I came home I googled it and came across the CDC website and this is what I saw. "The increase in the prevalence of isolates obtained through GISP with elevated cefixime MICs might indicate early stages of development of clinically significant gonococcal resistance to cephalosporins. CDC anticipates that rising cefixime MICs soon will result in declining effectiveness of cefixime for the treatment of urogenital gonorrhea." I don't understand all of that but I see that there are strains that are resistant to cefiixime should I be worried? Just want to finish my only exposures we're around 10 cases of unprotected oral in the last year how big of a risk was that. Thanks for your help I appreciate it.
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Welcome to our Forum.  I'll be glad to comment.  Before I comment on your treatment, let me point out that if I had seen you I would not have treated you at all.  STIs are relatively rare following receipt of oral sex and most gonorrhea is symptomatic.  I would have tested you, confident that your tests would be negative.

At this point however, even if you had gonorrhea, I would expect the combination of cefixime and azithromycin to cure your gonorrhea.  Although there are treatment failures reported when cefixme was treated with only cefixime, the combination of azithromycin and cefixime provides a 0ne-two punch that is more than 99% effective.  At this juncture, if you are still concerned, I would suggest testing, not taking additional antibiotics that you probably do not need. 

I hope this information is helpful.  Please follow-up if any part of this is unclear or you have further questions.  EWH
---
42 months ago
Thank you doctor isn't an occasional burning sensation when peeing a symptom? Also I don't mean to sound like I'm doubting you it's that I do have kind of a health anxiety my question is if the combination of these two drugs is 99% effective which I assume is the best you can say for any treatment why does the CDC recommend it only as an alternative treatment? 
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
While burning on urination is a symptom of Gonorrhea, e symptoms are not occasional but persistent.  Gonorrhea symptoms do not come and go.

The current recommendations for Gonorrhea treatment ( which I helped write) are designed not only to effectively treat gonorrhea but also to prevent emergence of resistance to either of the antibiotics used for treatment.  EWH
---
42 months ago
Just to make sure. what your saying is the reason for it is to combat future resistance not that one is more effective then the other. thanks for all your help
Edward W. Hook M.D.
Edward W. Hook M.D.
42 months ago
Correct.  In North America reported treatment failures have occurred when only cefixime and not the combination of cefixime and azithromycin were administered.  Further the treatment failures were more common at the pharynx and rectum than at genital sites. 

In my opinion, you are worrying entirely too much. Please remember, you do not know that you had gonorrhea and it is unlikely that you did.  You were treated "just in case" without testing. 

This is my 3rd reply to your questions.  As a result, as per Forum guidelines, this thread will be closed in a few hours.  I hope the information I  have provided is helpful to you. Take care.  EWH
---