Treatment of Gonococcal Proctitis: First-Line Antibiotic Management

Clinical Overview

Gonococcal proctitis is a rectal infection caused by Neisseria gonorrhoeae, presenting with symptoms such as anal discharge or perianal and anal pain. Prompt, guideline-directed antibiotic treatment is required, followed by confirmation of cure.

Treatment Approach

Management centres on a preferred first-line antibiotic regimen, with structured alternatives available for patients in whom the first-line option is not appropriate — for example, due to allergy or other contraindications. The full selection criteria, agent sequencing, and any combination considerations are contained within the complete protocol.

Treatment Goals

Success is defined as resolution of rectal symptoms (anal discharge, perianal or anal pain) and confirmed by a nucleic acid amplification test (NAAT) for Neisseria gonorrhoeae performed at least two weeks after treatment.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1177/09564624251345195

Ceftriaxone 1 g intramuscularly (IM) as a single dose (GRADE 1B).
Alternative regimens may be given because of allergy, needle phobia or other absolute or relative contraindications.
Assessment after treatment may be helpful to detect treatment failure and emerging resistance, confirm adherence to treatment, ensure resolution of symptoms, explore the possibility of reinfection, and confirm partner notification and health promotion.
We recommend TOC using NAAT should be performed at least two weeks after treatment (GRADE 1B).

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