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Guideline

Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (‎syphilis)‎ and new recommendations on syphilis testing and partner services.

Year of Publication
2024
Issuing Institution
World Health Organization
Links
WHO IRIS

Recommendations

12 included recommendations

For adults and adolescents (including pregnant women) with genital, anorectal and/or oropharyngeal gonococcal infections, WHO suggests: • ceftriaxone 1 g intramuscularly as a single dose. If ceftriaxone is not available or refused, WHO suggests: • cefixime 800 mg orally and performing test of cure. If test of cure is not possible or when oropharyngeal infection is diagnosed or is a potential concern, WHO suggests: • cefixime 800 mg orally plus azithromycin 2 g orally. When resistance, allergy or availability of cephalosporins is a concern, WHO suggests one of the following options: • spectinomycin 2 g intramuscularly as a single dose plus azithromycin 2 g orally; or • gentamicin 240 mg intramuscularly as a single dose plus azithromycin 2 g orally

Status
Updated

Recommended in favor

Conditional

Retreating gonococcal infections after treatment failure. If treatment failure occurred after a non-WHO-recommended treatment, WHO suggests retreating with a WHO-recommended therapy. If reinfection is suspected, WHO suggests retreating with a WHO-recommended therapy, reinforcing the need for sexual abstinence, condom use and partner treatment. If treatment failure occurred and antimicrobial susceptibility testing data are available, WHO suggests retreating according to susceptibility profile. If treatment failure occurred after a WHO-recommended therapy and reinfection is assessed to be unlikely, WHO suggests retreating with a regimen not used previously from one of the following options and performing test of cure: • ceftriaxone 1 g intramuscularly as a single dose plus azithromycin 2 g orally, only if ceftriaxone was not used previously; • spectinomycin 2 g intramuscularly as a single dose plus azithromycin 2 g orally; or • gentamicin 240 mg intramuscularly as a single dose plus azithromycin 2 g orally

Status
Updated

Recommended in favor

Conditional

For adults and adolescents with uncomplicated chlamydial infections (genital, anorectal and/or oropharyngeal), WHO suggests: • doxycycline 100 mg orally twice a day for 7 days. If doxycycline is not available or adherence to multiple doses is a serious concern, WHO suggests: • azithromycin 1 g orally as a single dose. If doxycycline and azithromycin are not available, WHO suggests one of the following options: • erythromycin 500 mg orally four times a day for 7 days; • ofloxacin 200–400 mg orally twice a day for 7 days; or • tetracycline 500 mg orally four times a day for 7 days

Status
Updated

Recommended in favor

Conditional

Early syphilis (primary, secondary and early latent syphilis of not more than two years’ duration) in pregnant women. If benzathine penicillin is not available, WHO suggests: • procaine penicillin 1.2 million units intramuscularly once daily for 10 days. In rare situations when benzathine or procaine penicillin cannot be used (e.g. due to confirmed penicillin allergy, which occurs in less than 3% of the population, and where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), WHO suggests one of the following options with caution and enhanced follow-up: • ceftriaxone 1 g intramuscularly once daily for 10–14 days; or • erythromycin 500 mg orally four times daily for 14 days.

Status
Updated

Recommended in favor

Conditional

Late syphilis (late latent and tertiary syphilis of more than two years’ duration without evidence of treponemal infection) or unknown duration in pregnant women. If benzathine penicillin is not available, WHO suggests: • procaine penicillin 1.2 million units intramuscularly once daily for 20 days. In rare situations when benzathine or procaine penicillin cannot be used (e.g. due to confirmed penicillin allergy, which occurs in less than 3% of the population, and where penicillin desensitization is not possible) or are not available (e.g. due to stock-outs), WHO suggests using, with caution and enhanced follow-up: • erythromycin 500 mg orally four times daily for 30 days.

Status
Updated

Recommended in favor

Conditional

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