Gonorrhoea is a bacterial sexually transmitted infection that is commonly remedied with combination antibiotic treatment, involving two medicines. The most widely-prescribed options are Azithromycin and Suprax. They are usually administered as one-off doses which should be enough to help the immune system fight of the infection. In most cases, improvement will be noticeable within a couple of days after the administration of the medicines.

Although both Azithromycin and Suprax are antibiotic medicines, they work in somewhat different ways. In addition to that, neither of the two can be equally effective when taken on its own which is why gonorrhoea treatment always involves the combination of both.

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How effective is combination antibiotic treatment of gonorrhoea?

However, this combination antibiotic treatment is the second-best option – medical experts still firmly stand behind the claim that the most effective gonorrhoea treatment with the highest success rate is the combination of Azithromycin and another antibiotic that is administered via an injection in a clinic and by a medical professional.

This is especially true for more resilient strains of gonorrhoea-causing bacteria which can survive even this combined treatment. These strains sometimes referred to as “super gonorrhoea” will usually require the recommended first-line treatment. The combination of Azithromycin and Suprax should thus be used only if you cannot get the injection for whatever reason.

What exactly is gonorrhoea?

Gonorrhoea, also colloquially called “the clap” is the second most common sexually transmitted disease in the UK. According to NHS, somewhere between 25.000 and 30.000 new cases get discovered every year at British GUM and STI clinics. It is classified as a bacterial STI since it is caused by a strain of bacteria called Neisseria gonorrhoeae. In those affected, bacteria can be found in semen and vaginal fluid alike, from where it is spread via unprotected sex, regardless of whether it is vaginal, oral or anal. Sharing of sex toys is another possible method of transmission, so is the possibility of affected mother passing the condition to a child during childbirth.

In many cases, gonorrhoea can remain asymptomatic, with one in ten male cases and up to 50% of all female cases failing to notice any signs of the infection. However, even when dormant, this condition is equally contagious and can be passed on during unprotected sex, just like in those instances where flare-up of the symptoms is present.

The common symptoms include vaginal or penile discharge, usually yellowish or green in colour, painful urination and, in female cases, pain and discomfort in the lower abdomen as well as more intensive menstrual bleeding and bleeding between periods. Some men may also notice inflammation of the foreskin of the penis and pain in testicles.

How dangerous is gonorrhoea?

When left untreated, gonorrhoea can lead to significant fertility problems, so it is very important to get tested for the condition if there is any suspicion you might affected – that is, if you had unprotected sex with a partner for whom you cannot be sure is not infected. By early detection, you can significantly increase the chances of successful and fast treatment, sometimes even limiting and eliminating the infection before any symptoms manifest and before any permanent damage is caused to the reproductive system.

However, despite this risk, gonorrhoea is a condition that can be easily treated. As is the case with all bacterial STIs, gonorrhoea too can be successfully treated with antibiotic medication. In the past, doctors commonly prescribed penicillin, but this had an, at the time, unforeseen side effect – throughout the decades, gonorrhoea became much more resilient to common treatment, with more impervious strains appearing throughout Europe. This made the condition less likely to be effectively cured with just a single antibiotic used on an independent basis. Instead, the most commonly prescribed method of treatment today is combination antibiotic treatment, involving two different antibiotics.

Gonorrhoea treatment in the UK

In the United Kingdom, the most widely used gonorrhoea treatment is an antibiotic injection that is administered in parallel to antibiotic tablet. Keep in mind that this injection can be administered only by a certified medical professional.

In certain cases, when the injection cannot be used, for whatever reason, combination of two tablet antibiotics can be prescribed instead. However, due to somewhat lower efficiency of this approach as compared to injection and tablet method, this will be recommended only if the person affected cannot receive the injection. This can happen if the patient is allergic to some of the elements of injectable treatment or, for example, if one is afraid of needles.

Azithromycin and Suprax both aim to neutralize the injection, although they aim to achieve this in somewhat different ways. More specifically, they disrupt different vital cellular functions and processes that are essential for bacteria in order to survive, replicate and spread.

The active ingredient of Suprax, cefixime works by disrupting the stability of bacterial cellular membrane, creating gaps in it, thus making the inner components of the bacterial cell seep out into the environment and opposing substances entering it. This compromises the stability of bacterial cell membranes, effectively killing it.

On the other hand, Azithromycin attempts to compromise the bacterial cell’s ability to synthesize a vital enzyme used for sustaining the cell and helping it replicate. This mechanism of action will, as opposed to that of Suprax, simply stop the infection from spreading, allowing the immune system to fight off the remaining bacteria.

After the treatment has been concluded, it will be necessary for you to get tested once more in order to confirm that the infection has indeed been eliminated.

Diagnosing gonorrhoea

If you have any reason to suspect you might be infected, it is vital that you get tested as soon as possible. You can do that either through a GUM or STI clinic, which is considered to be a more conventional way, or alternatively you can order an at-home STI testing kit which you can use to get tested. If you opt for a home test kit, you will be provided with all the devices necessary to collect needed samples (urine sample and vaginal swab for women) which you will then post to a clinic. Once the results are in, you will be notified via your preferred method of contact.

How is combined antibiotic gonorrhoea treatment used?

Whether you use injection and tablet method or two tablet medicines, you will be provided with all the necessary guidelines and instructions by your doctor. Be sure to always follow those instructions precisely.

When taking Azithromycin and Suprax, the usual dose is 400mg of the latter (two 200mg Suprax tablets) and 1000mg of the former (two 500mg or four 250mg of Azithromycin).

In addition, it is important to note that you should do your best to avoid alcohol over the course of this treatment and refrain from drinking for additional 48 hours after taking the last dose.

After some time, it might be a good idea to get tested again so you can ensure that the treatment has been effective.

Azithromycin side effects

Frequency of occurrence

Side effects

Very common (1 in 10 users or more)

Abdominal pain, diarrhoea, nausea, flatulence, indigestion

Common (1 in 10 users or less)

Loss of appetite, headache, dizziness, numbness, stomach pain, rashes, fatigue

Uncommon (1 in 100 users or less)

Fungal or bacterial infection, hypersensitivity, insomnia, palpitations, shortness of breath, moth ulcers, sweating, painful urination

Rare (1 in 1000 users)

Liver and kidney problems


Very rare

Gut infection, anxiety, confusion, convulsions, fainting, pancreatitis, discoloration of the tongue, liver failure

 Suprax side effects

Side effects of Suprax are rather rare, but can be uncomfortable and distressing. They include:

  • General malaise
  • Allergic reaction
  • Diarrhoea
  • Headaches
  • Dizziness

Gonorrhoea pack interactions

Gonorrhoea combination treatment might not be suitable for individuals who are currently using, or have recently use any of the following medicines:

  • Ergotamine
  • Statins
  • Quinidine
  • Warfarin
  • Nelfinavir
  • Rifabutin
  • Alfentanil
  • Antacids
  • Digoxin
  • Astemizol
  • Pimozide

Gonorrhoea combination treatment contraindications

In addition, gonorrhoea combination treatment might not be suitable for people who are affected by some of the following health conditions:

  • Diabetes
  • Liver or kidney problems
  • Bowel disease
  • Severe heart problems
  • Neurological and psychiatric illnesses
  • Allergy to antibiotics
  • Nut allergy