Amoxicillin for gonorrhea: Is it effective?

In this article:

• Does amoxicillin treat gonorrhea?
• Dosage
• How long does it take amoxicillin to work?
• Side effects
• What is the best antibiotic to cure gonorrhea?

In this article

• Does amoxicillin treat gonorrhea?
• Dosage
• How long does it take amoxicillin to work?
• Side effects
• What is the best antibiotic to cure gonorrhea?

Gonorrhea is caused by a bacteria named Neisseria gonorrhoeae. Gonorrhea is a sexually transmitted infection, which means it’s spread by sexual contact (vaginal, oral, or anal) and can infect your genitals, anus, and mouth. It can also be passed from a mother to her baby during childbirth. Gonorrhea infections are most prevalent among young adults. While gonorrhea doesn’t always cause symptoms, when it does, it can cause pain during urination, unusual genital discharge, and bleeding between periods. In women, untreated gonorrhea can lead to pelvic inflammatory disease and infertility.

Since gonorrhea is a bacterial infection, it’s treated with antibiotics. If you’ve been diagnosed with this sexually transmitted disease (STD), you may be wondering: Can amoxicillin treat gonorrhea? Amoxicillin is a well-known antibiotic, but it’s not used for gonorrhea. That’s because gonorrhea has developed antibiotic resistance to amoxicillin, meaning that amoxicillin isn’t able to eliminate gonorrhea and is not an effective option. Instead, the first-line treatment for gonorrhea is a single-dose intramuscular injection of the antibiotic ceftriaxone, a type of cephalosporin antibiotic.

Read on for more information about amoxicillin for gonorrhea, including why it’s not the best treatment for the condition, and what to know about recommended treatment options for this STD. 

Does amoxicillin treat gonorrhea? 

It’s common to wonder: Can amoxicillin cure gonorrhea? That’s because amoxicillin is a popular antibiotic. But while amoxicillin may be a good choice for treating other bacterial infections, such as lower respiratory tract infections and urinary tract infections, it’s not a good choice for gonorrhea.

“Amoxicillin is not recommended as an effective treatment for gonorrhea,” says Soma Mandal, MD, an internist at Summit Health. And why is this? While in the past, amoxicillin and other antibiotics were used to treat gonorrhea, that is not the case anymore. “Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, has developed resistance to many antibiotics that were previously effective, including amoxicillin,” Dr. Mandal explains.

It’s not just amoxicillin that’s not effective against gonorrhea. According to the CDC, gonorrhea has also developed resistance to a class of antibiotics called fluoroquinolones. Resistance to azithromycin has been demonstrated in gonorrhea as well. As of now, the only antibiotic that is able to effectively treat gonorrhea is ceftriaxone.

As Eboni January, MD, OB-GYN and fellow of the American College of Obstetricians and Gynecologists (FACOG) explains, the preferred treatment for gonorrhea is a single-dose intramuscular injection of ceftriaxone, which is a third-generation cephalosporin. “The CDC and WHO (World Health Organization) recommend ceftriaxone as the first-line treatment because of its effectiveness and the resistance pattern of gonorrhea,” says Dr. January. “Ceftriaxone covers most strains of gonorrhea, and its intramuscular administration ensures high tissue concentration, which is particularly important for clearing the infection.”

Sometimes other treatments may be considered, according to Dr. January. “In cases where chlamydia coinfection is suspected, doxycycline (100 mg twice daily for 7 days) is also commonly prescribed, as these two sexually transmitted infections often occur together,” she explains. But there isn’t a scenario where you would be prescribed amoxicillin for gonorrhea, Dr. January emphasizes.

Recommended amoxicillin dosages

If you are looking for information about how to treat gonorrhea with amoxicillin, you might want to know about amoxicillin dosages for gonorrhea. Nonetheless, because amoxicillin is rarely, if ever, used to treat gonorrhea, there is no recommended dosage of amoxicillin for gonorrhea.

Still, we can look to the past to see what amoxicillin dose for gonorrhea might look like. “If amoxicillin were used (although this is not recommended due to resistance), older regimens would have required high doses (e.g., 3 grams) taken with probenecid to slow renal clearance,” explains Dr. January. “However, this is far from current practice.”

According to the CDC, the typical dosage of ceftriaxone for gonorrhea is 500 mg given as an intramuscular injection. This is the only CDC-recommended treatment for uncomplicated cases of gonorrhea that involve the genitals, anus, or mouth.

How long does it take amoxicillin to work?

Amoxicillin is not used to treat gonorrhea, but if it were used, it would take several days to work, Dr. January says. But, “given the resistance patterns of Neisseria gonorrhoeae, it may not be effective at all,” she says.

 If you use the preferred treatment for gonorrhea (ceftriaxone injection), symptoms should start improving within a few days, Dr. January says. “You’ll know the antibiotic is working when symptoms, such as pain during urination, genital discharge, or pelvic discomfort, begin to improve,” she describes.

Healthcare providers may perform a “test of cure” to ensure that the infection has totally cleared. Dr. January says this is used more often in certain populations, such as those with persistent symptoms or pregnant women.

What happens if gonorrhea symptoms don’t go away even after taking the recommended antibiotics? You should follow up with your healthcare provider in this case. Often, it’s not that the ceftriaxone treatment didn’t work, but that you got reinfected with gonorrhea. Either way, you should seek medical attention. Your doctor will discuss next steps with you, which will likely involve another course of antibiotic treatments.

Side effects of amoxicillin

Amoxicillin is not used to treat gonorrhea. However, there are some common side effects of amoxicillin to be aware of. Typical amoxicillin side effects include:

• Upset stomach
• Nausea
• Vomiting
• Diarrhea
• Temporary tooth discoloration, typically browning, graying, or yellowing of the teeth

If you are treated for gonorrhea, you will likely be treated with an intramuscular ceftriaxone injection. These ceftriaxone injections may cause side effects. These include:

• Pain, tenderness, warmth, or a firm spot at the site of the injection site
• When exercising, you may experience shortness of breath or weakness
• Upset stomach and diarrhea

What is the best antibiotic to cure gonorrhea?

Again, amoxicillin is almost never used to treat gonorrhea. “The best and preferred antibiotic for gonorrhea is ceftriaxone due to its high effectiveness and the widespread antibiotic resistance that has made drugs like amoxicillin obsolete in treating this infection,” Dr. January explains.

As Dr. Mandal notes, this recommendation aligns with the current guidelines from the CDC, which recommend intramuscular ceftriaxone. “It is crucial to adhere to these guidelines to ensure successful treatment and reduce the spread of resistant strains,” she emphasizes.

However, although intramuscular ceftriaxone is the preferred gonorrhea treatment, alternative regimens may be used at times. According to Dr. Mandal, these include:

• Ceftizoxime intramuscularly
• Cefoxitin intramuscularly
• Cefotaxime intramuscularly
• Oral cefixime

If patients have had allergic reactions to cephalosporins, then a combination of oral azithromycin plus intramuscular gentamicin may be used to treat gonorrhea, Dr. Mandal says. At the same time, as Dr. January shares, allergic reactions to cephalosporins like ceftriaxone are rare. “Alternate regimens involving other antibiotics like gentamicin or spectinomycin are preferred in cases of severe allergies to cephalosporins,” she explains.