Introduction The number of private online sexually transmitted infection testing and treatment providers in England is increasing. While over 90% of gonorrhoea cases seen at sentinel specialist sexual health clinics in England are prescribed the recommended dual therapy of ceftriaxone (intramuscular) and azithromycin (oral), the extent to which private online providers adhere to national treatment guidelines is unclear. We systematically reviewed online search results to assess the antibiotic courses prescribed for gonorrhoea treatment.

Methods A Google search for ‘gonorrhoea treatment online’ was performed using a private internet browsing session of Chrome in November 2016. The first 2 pages of search results were reviewed to assess whether they were links to gonorrhoea treatment providers and, if so, which antibiotic course was available for purchase. A thematic analysis of the medical advice given online was also performed, and frequencies and proportions are reported.

Results There were 27 unique results on the first 2 pages of search results, 17 (63%) of which were to online providers. Among these, upon clicking a checkbox to indicate having been diagnosed with gonorrhoea, 71% (12/17) provided a course of antibiotics for treatment. However, only 1 of these required visiting a terrestrial pharmacy for the recommended dual therapy; the remainder (11/12) provided cefixime and azithromycin tablets for gonorrhoea treatment via next-day delivery. On their websites, online providers widely acknowledged that ‘an injection’ [of ceftriaxone] is more effective for gonorrhoea treatment, but suggested that it was ‘acceptable’ to prescribe azithromycin and cefixime.

Conclusion Non-recommended antibiotic courses for the treatment for gonorrhoea are easily accessible online. There is a need to raise awareness among online providers and the public of the recommended dual therapy for gonorrhoea. To prevent the further emergence of antibiotic resistance in Neisseria gonorrhoeae, adherence to the recommended dual therapy in all settings is essential.