This seems to come up on the Asia board a lot.

So here it is in black and white. While many will say they will need to take more because of the "Asian resistant strains" I would encourage people to start with at least the CDC recommended dosage and then go from there. The CDC recommendations for Gonorrhea take into account travel history and the resistant strains. And 1000 mg zithromax for Chlamydia has been the gold standard for a while.

2006 CDC Sexually Transmitted Diseases Treatment Guidelines

http://www.cdc.gov/std/treatment/2006/toc.htm

The two most recurring requests seem to be Chlamydia and Gonorrhea.

http://www.cdc.gov/std/treatment/2006/urethritis-and-cervicitis.htm#uc4

Chlamydia Recommended Regimens

Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days

The 2006 Gonorrhea Recommendations don't apply and they have been updated to this:

http://www.cdc.gov/std/treatment/2006/updated-regimens.htm

Gonorrhea Recommended Regimens

Ceftriaxone 125 mg IM in a single dose
OR
Cefixime 400 mg orally in a single dose or 400 mg by suspension (200 mg/5ml)
PLUS
TREATMENT FOR CHLAMYDIA IF CHLAMYDIAL INFECTION IS NOT RULED OUT

Ceftriaxone/Rochephin is a shot, so unless one has access to a doctor, Cefixime is probably the better way to go if self medicating.

* These regimens are recommended for all adult and adolescent patients, regardless of travel history or sexual behavior.

Absolutely no evidence that more is better.

If the strain is resistant taking more will not help.

IM Rocephin is the far preferred treatment.

I beg to slightly differ: the resistance patterns are based on in vitro studies. As the bioavailability in different organs/areas of the body varies a higher dose may in fact help in erradicating the infection.

On the other hand if you have access to an alternative drug that does the trick no need to roll the dice.

Concarne

I was talking specifically about RX of GC. Not a hypothetical infection in an unknown organ.

For sure the same bacteria in different organs requires different dosages often due to tissue penetration of the antibiotic.On occasion an antibiotic can be useless against an organism that is highly sensitive to it because it does not penetrate or concentrate sufficiently in a particular organ.

I have never seen <500 mg of ceftriaxone prescribed in SE Asia. The CDC is notoriously behind the curve on Asian strains of STD's.

Actually, CDC was ahead of the curve, and was recommending use of ceftriaxone/cefixime soon after the discovery of strains of floroquinolone-resistant strains of gonorrhea in Asia, and in many parts of Asia docs are still giving people cipro and related drugs. CDC was recommending ceftriaxone/cefixime before 2007 for travelers to Asia and folks falling into a few other risk categories, and in 2007 quit recommending floroquinolones altogether, regardless of travel history.

Ceftriaxone was the prescribed drug of choice in SEA as early as 2004.

Next?

Sorry, 500mg ceftriaxone injections prescribed as early as 2004. I'd LOVE to hear a qualified STD expert say that 125 mg is "Same same" as 500 mg for a 200+ lb. male.

The fine folks at the local STD clinic presumably follow CDC recommendations and always efficiently make my problems go away.

OK, I'll call the STD clinic tomorrow and ask them exactly how much Rocephin they shot me up with last week. It knocked out some particularly unpleasant AC clap in 24 hours. I'm supposed to call them back anyway to get my Syphilis test results although I figure they would have called me by now if that was positive.

Quote from last Asia chat archive. So, did you call them? What was the answer?

I nominate Sancho for CDC test case #1, 1A, 1B, et. al!!!

You got me. I never did call them back. I meant to but the problem went away and I was busy. They always gripe at me for not calling them back. Last time I only did PCR HIV test (negative) so it was a different set of folks and they didn't have my rather thick folder in their possession for me to inquire about.

Porker
Most antibiotic dosages like many drugs do not need to be adjusted for weight.

If a strain is resistant to 125mg of rocephin it will be resistant to 500 mg as well. Increasing the dose does not increase the effectiveness.The suggested dose already supplies a bacteria killing ratio for sensitive organisms far beyond what is needed.

More is better does not always apply to everything.

I had the thick folder and held my head in shame when going into the clinic nearby. The solution I found is to go to the clinic one town over, there you'll have a nice new thin folder!

If you're positive for anything, they will call you without a doubt.

i thought you could take a z pak 1000 mg of zith to cure both chlamydia and ghon.

1000 mg zithromax will not cure gonorrhea. It will only cure chlamydia.

2000 mg will cure uncomplicated gonorrhea, but see below. Its use should be limited.

From the updated regimens link:

http://www.cdc.gov/std/treatment/2006/updated-regimens.htm

Since there are limited data regarding alternative regimens for treating gonorrhea among persons who have documented severe cephalosporin allergy, expert infectious diseases consultation is recommended; the best available treatment option is cephalosporin treatment following desensitization. If desensitization is not an option, azithromycin may be considered. Azithromycin 2 grams orally is effective against uncomplicated gonococcal infection, but concerns over emerging antimicrobial resistance to macrolides should restrict its use to limited circumstances.

(Message edited by xenono on January 26, 2010)

They also recommend much higher doses than normal for anal gonorrhoea,,,, that is,,,, if anyone here has a problem with anal gonorrhoea.

Personally, I've never had a problem with anal gonorrhea, but I can't speak to whether the same applies to Mr. Homo (as described in Asia chat).

I can imagine your poor doc's reaction when you tell him/her "I get a burning sensation when I take a shit - or take a dick in the ass".