Condition

Gonorrhea

Bacterial sexually transmitted infection

40M
People Affected
25
Active Trials
82.4M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Ceftriaxone
98% Effectiveness• 98% Confidence• 70% Safety• 17 trials• 100K participants
HIGH EvidenceExcellent ValueDose: 500 mg IM single dose
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
Antibiotics💉
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70
DangerousModerateSafe

Time to Effect

24-48 hours

Duration

Single IM dose

Response Rate

98%

Remission Rate

98%

Number Needed to Treat (NNT)

1

Common Side Effects:

Injection site pain: 15%
Diarrhea: 7%
Nausea/Vomiting: 2%
Rash: 1%
Headache: 1%

Annual Cost of Care

Drug Cost

$20

Monitoring

$300

Side Effects

$10

Total Annual

$330

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Remission

$336.73

Cost per Responder

$336.73

Treatment Outcomes
Primary Outcomes
Presence of N. gonorrhoeae (Genital)100% positive
-98.5% (Reduced from 100% to 1.5% positive)
Presence of N. gonorrhoeae (Pharyngeal)100% positive
-97% (Reduced from 100% to 3.0% positive)
Presence of N. gonorrhoeae (Rectal)100% positive
-98% (Reduced from 100% to 2.0% positive)
Gonorrhea Symptom Severity (0-10 scale)7/10 points
-93% (-6.5 points)
Secondary Benefits
Risk of Pelvic Inflammatory Disease (PID) in women15% risk (untreated)
-96.7% (Reduced to <1% risk)
Risk of Epididymitis in men5% risk (untreated)
-90% (Reduced to <1% risk)
Risk of Disseminated Gonococcal Infection (DGI)2% risk (untreated)
-95% (Reduced to <0.1% risk)
Common Side Effects
Injection site pain
+15%
Diarrhea
+7%
Nausea/Vomiting
+2%

Clinical Trial Phases:

Phase 4
2
Spectinomycin
97% Effectiveness• 90% Confidence• 70% Safety• 100 trials• 20K participants
HIGH EvidenceGood ValueDose: 2 g IM single dose
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

Rapid

Duration

Single IM dose

Response Rate

97%

Remission Rate

97%

Number Needed to Treat (NNT)

1

Common Side Effects:

Injection site pain: 15%
Nausea: 2%
Dizziness: 1%
Fever: 1%

Annual Cost of Care

Drug Cost

$75

Monitoring

$300

Side Effects

$5

Total Annual

$380

Cost-Effectiveness

GOOD

QALYs Gained

0.05

Cost per Remission

$391.75

Cost per Responder

$391.75

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+97%
Response Rate
+97%
Remission Rate
+97%
Common Side Effects
Injection site pain
+15%
Nausea
+2%
Dizziness
+1%

Clinical Trial Phases:

Phase 4
3
Doxycycline
95% Effectiveness• 95% Confidence• 70% Safety• 9 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 100 mg orally twice daily for 7 days
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

Days

Duration

7 days

Response Rate

95%

Remission Rate

95%

Number Needed to Treat (NNT)

1

Common Side Effects:

GI upset (nausea, vomiting, diarrhea): 15%
Photosensitivity: 10%
Esophageal irritation/ulceration: 1%
Vaginal candidiasis: 5%

Annual Cost of Care

Drug Cost

$15

Monitoring

$300

Side Effects

$5

Total Annual

$320

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Remission

$336.84

Cost per Responder

$336.84

Treatment Outcomes
Primary Outcomes
Prevalence of Neisseria gonorrhoeae Infection100% positive for N. gonorrhoeae (culture or NAAT)
-85% (-85 percentage points (from 100% to 15%))
Prevalence of Urethral Discharge80% of symptomatic males at presentation
-87.5% (-70 percentage points (from 80% to 10%))
Prevalence of Dysuria60% of symptomatic patients at presentation
-90% (-54 percentage points (from 60% to 6%))
Secondary Benefits
Prevalence of Chlamydia trachomatis Infection (in co-infected patients)100% positive for C. trachomatis (culture or NAAT)
-95% (-95 percentage points (from 100% to 5%))
Incidence of Pelvic Inflammatory Disease (PID)10% over 3-month follow-up (in untreated or inadequately treated females)
-70% (-7 percentage points (from 10% to 3%))
Incidence of Epididymitis5% over 3-month follow-up (in untreated or inadequately treated males)
-80% (-4 percentage points (from 5% to 1%))
Common Side Effects
GI upset (nausea, vomiting, diarrhea)
+15%
Photosensitivity
+10%
Esophageal irritation/ulceration
+1%

Clinical Trial Phases:

Phase 4
4
Azithromycin
93% Effectiveness• 90% Confidence• 70% Safety• 18 trials• 70K participants
HIGH EvidenceExcellent ValueDose: 1g or 2g orally single dose (2g with Gentamicin)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

Rapid

Duration

Single oral dose

Response Rate

93%

Remission Rate

93%

Number Needed to Treat (NNT)

1

Common Side Effects:

Nausea, vomiting, diarrhea, abdominal pain: 10%
Headache: 2%
QT prolongation: 0.1%

Annual Cost of Care

Drug Cost

$40

Monitoring

$300

Side Effects

$5

Total Annual

$345

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

Cost per Remission

$370.97

Cost per Responder

$370.97

Treatment Outcomes
Primary Outcomes
Microbiological Eradication Rate (Urethral/Cervical Gonorrhea)Positive Neisseria gonorrhoeae culture at baseline
+93% (93% of patients achieved negative culture)
Resolution of Clinical Symptoms (Urethritis/Cervicitis)Presence of symptomatic urethritis/cervicitis
+95% (95% of patients reported symptom resolution)
Microbiological Eradication Rate (Rectal Gonorrhea)Positive Neisseria gonorrhoeae culture at baseline
+88% (88% of patients achieved negative culture)
Secondary Benefits
Microbiological Eradication Rate (Pharyngeal Gonorrhea)Positive Neisseria gonorrhoeae culture at baseline
+85% (85% of patients achieved negative culture)
Reduction in Risk of Pelvic Inflammatory Disease (PID)10-20% risk of PID if untreated
-90% (Risk reduced by approximately 90% relative to untreated)
Reduction in Duration of N. gonorrhoeae SheddingWeeks to months of infectivity if untreated
-95% (Infectivity reduced from weeks/months to days post-treatment)
Common Side Effects
Nausea, vomiting, diarrhea, abdominal pain
+10%
Headache
+2%
QT prolongation
+0.1%

Clinical Trial Phases:

Phase 4
5
Gentamicin
93% Effectiveness• 85% Confidence• 65% Safety• 3 trials• 5K participants
MODERATE EvidenceGood ValueDose: 240 mg IM single dose (with Azithromycin 2g)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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Water💧
65
DangerousModerateSafe

Time to Effect

Rapid

Duration

Single IM dose

Response Rate

93%

Remission Rate

93%

Number Needed to Treat (NNT)

2

Common Side Effects:

Injection site pain: 10%
Headache: 2%
Nausea: 2%
Nephrotoxicity/Ototoxicity (rare with single dose): 0.1%

Annual Cost of Care

Drug Cost

$15

Monitoring

$300

Side Effects

$10

Total Annual

$325

Cost-Effectiveness

GOOD

QALYs Gained

0.04

Cost per Remission

$349.46

Cost per Responder

$349.46

Treatment Outcomes
Primary Outcomes
Microbiological Eradication of N. gonorrhoeae (Urogenital)Proportion of infected sites: 1.0
-95% (-0.95 (reduction in proportion of positive sites))
Clinical Symptom ResolutionProportion of symptomatic patients: 1.0
-90% (-0.90 (reduction in proportion of symptomatic patients))
Dysuria Severity Score5/10 (moderate dysuria)
-80% (-4 points)
Genital Discharge Severity2/3 (moderate discharge)
-75% (-1.5 points)
Secondary Benefits
Incidence of Pelvic Inflammatory Disease (PID) in FemalesEstimated PID incidence in untreated N. gonorrhoeae: 10%
-90% (-9 percentage points (from 10% to 1%))
Genital Health-Related Quality of Life60/100 (moderate impairment)
+25% (+15 points)
Pain Intensity (Visual Analog Scale)4/10 (moderate pain)
-75% (-3 points)
Common Side Effects
Injection site pain
+10%
Headache
+2%
Nausea
+2%

Clinical Trial Phases:

Phase 4
6
Cefixime
88% Effectiveness• 75% Confidence• 70% Safety• 10 trials• 20K participants
MODERATE EvidenceModerate ValueDose: 800 mg orally single dose
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

Rapid

Duration

Single oral dose

Response Rate

88%

Remission Rate

88%

Number Needed to Treat (NNT)

2

Common Side Effects:

Diarrhea: 10%
Nausea: 5%
Abdominal pain: 5%
Headache: 2%

Annual Cost of Care

Drug Cost

$45

Monitoring

$350

Side Effects

$5

Total Annual

$400

Cost-Effectiveness

MODERATE

QALYs Gained

0.04

Cost per Remission

$454.55

Cost per Responder

$454.55

Treatment Outcomes
Primary Outcomes
Urogenital Neisseria gonorrhoeae Detection Rate100% (all patients positive by NAAT/culture)
-95% (-95 percentage points (from 100% to 5%))
Resolution of Urogenital Symptoms (e.g., discharge, dysuria)6/10 (moderate symptom severity on a 0-10 scale)
-83.3% (-5 points (from 6/10 to 1/10))
Pharyngeal Neisseria gonorrhoeae Detection Rate100% (all patients positive by NAAT/culture)
-85% (-85 percentage points (from 100% to 15%))
Secondary Benefits
Rectal Neisseria gonorrhoeae Detection Rate100% (all patients positive by NAAT/culture)
-90% (-90 percentage points (from 100% to 10%))
Pain Score (0-10 Visual Analog Scale)5/10 (moderate pain)
-80% (-4 points (from 5/10 to 1/10))
Common Side Effects
Diarrhea
+10%
Nausea
+5%
Abdominal pain
+5%

Clinical Trial Phases:

Phase 4