Typically, treatment for both gonorrhea and chlamydia is indicated, if one entity is suspected.

Standard
Gonorrhea
Ceftriaxone IM x 1
500 mg, if weight <150 kg
1 g, if weight ≥150 kg
Chlamydia
Nonpregnant: doxycycline 100 mg PO BID x 7 days
Pregnant: azithromycin 1 g PO x 1
Ceftriaxone IM x 1
500 mg, if weight <150 kg
1 g, if weight ≥150 kg
500 mg, if weight <150 kg
1 g, if weight ≥150 kg
Nonpregnant: doxycycline 100 mg PO BID x 7 days
Pregnant: azithromycin 1 g PO x 1
Ceftriaxone contraindicated
Gonorrhea
Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
Cefixime 800 mg PO x 1
Chlamydia^
Nonpregnant: doxycycline 100 mg PO BID x 7 days
Pregnant: azithromycin 1 g PO x 1
Gentamicin 240 mg IM x 1 PLUS azithromycin 2 g PO x 1, OR
Cefixime 800 mg PO x 1
Nonpregnant: doxycycline 100 mg PO BID x 7 days
Pregnant: azithromycin 1 g PO x 1
^Additional chlamydia coverage only needed if treated with cefixime only
Gonorrhea
Cefixime 800mg PO x 1
Chlamydia
Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
Pregnant: azithromycin 1g PO x 1
Cefixime 800mg PO x 1
Nonpregnant: doxycycline 100mg PO BID x 7 days, OR
Pregnant: azithromycin 1g PO x 1
Penicillin G 2.4mil IM x1
Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes
Consider in patients with bloody discharge, perianal or mucosal ulcers, chlamydia NAAT+, and MSM
Extend doxycycline 100mg PO BID for 21 days total
Proctitis
Anal fissure
Prostatitis
Anal fistula
Cervicitis
Anal malignancy
Vulvovaginitis
Anal tags