Dysuria, discharge
Test: Urethral Gram stain (men) + NAAT for gonorrhea AND chlamydia
Treat BOTH empirically: Ceftriaxone 500 mg IM if <150 kg (1 g IM if ≥150 kg; CDC 2021) (gonorrhea) + Doxycycline ×7 d (chlamydia)
Treat partners
Order set
- NAAT (GC + chlamydia)
- Urethral Gram stain (men)
- HIV/syphilis screen
- Partner notification
Criteria
AdmitRarely (disseminated gonococcal)
DischargeTreated (dual), partner notification, test-of-cure if indicated
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Systemic/disseminated gonococcal infection
Differentials
- UTI
- Prostatitis
- Reactive arthritis
Common mistakes
- Treating only one organism
- Not testing/treating partners
- If chlamydia excluded by NAAT → ceftriaxone monotherapy; test-of-cure only if pharyngeal; consider M. genitalium in persistent urethritis (CDC 2021)
Disposition & follow-up
Empirical dual therapy; test-of-cure/partner treatment; test-of-cure only if pharyngeal infection.
Discharge package
MedicationsCompleted dual therapy
Follow-upTest-of-cure if indicated; partner treatment
LifestyleBarrier protection; abstain until treated
Warning symptomsPersistent discharge, joint/eye symptoms
💊 Treatment detail — doses & preparation
Ceftriaxone3rd-gen cephalosporin
Dose2 g IV OD (meningitis 2 g q12h); gonorrhoea 500 mg–1 g IM once
PreparationIV: 2 g in 50–100 mL NS over 30 min; IM: reconstitute with lidocaine 1%
MonitorBiliary sludging; avoid with calcium-containing IV fluids in same line
Doxycyclinetetracycline
Dose100 mg BD (urethritis ×7 d, atypical CAP, tick-borne)
Preparation100 mg capsules with full glass of water, stay upright 30 min
MonitorPhotosensitivity, oesophagitis; avoid in pregnancy/children <8
Azithromycinmacrolide
DoseCAP: 500 mg OD ×3–5 d; chlamydia 1 g once; dysentery 500 mg OD ×3 d
PreparationPO tablets/suspension; IV 500 mg in 250 mL over 1 h if NBM
MonitorQT prolongation; resistance rising in gonorrhoea (not monotherapy)
📖 CDC / BASHH STIReviewed July 2026