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STDs & Sexual Health

What is the Treatment for Drug-Resistant Gonorrhea?

Linda Girgis | MD

Medically reviewed by Linda Girgis | MD, Girgis Family Medicine on August 21st, 2026.

Drug-resistant gonorrhea requires combination antibiotic therapy, typically ceftriaxone plus azithromycin. The CDC recommends dual therapy because single-drug treatments have failure rates exceeding 30% for resistant strains. Ceftriaxone 500mg intramuscularly combined with azithromycin 1g orally remains the standard first-line treatment. For patients with severe allergies or confirmed ceftriaxone resistance, alternative regimens include gentamicin plus azithromycin or cefixime plus azithromycin. Treatment failure occurs in approximately 5-7% of cases with resistant strains. Close follow-up testing 7-14 days after treatment is essential to confirm cure, especially for pharyngeal infections which show higher resistance rates.

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