A sexually active adolescent with positive tests for N. gonorrhoeae and C. trachomatis wants treatment today. Which regimen should be ordered?

A sexually active adolescent with positive tests for N. gonorrhoeae and C. trachomatis wants treatment today. Which regimen should be ordered?

• A. Azithromycin 1 g PO in a single dose
• B. Ceftriaxone 250 mg IM and azithromycin 1 g PO one time each
• C. Doxycycline 100 mg PO bid for 7 days
• D. Erythromycin base 500 mg PO qid for 7 days

Answer: (B)

If someone has gonorrhea with a high likelihood of concurrent chlamydia, the best approach is dual therapy that directly treats both infections in a single visit. Gonorrhea has shown resistance to many antibiotics, so the recommended regimen includes an injectable cephalosporin to reliably cover Neisseria gonorrhoeae. Pairing that with a single-dose agent that covers Chlamydia trachomatis ensures both infections are treated at once, reducing the chance of ongoing infection and transmission. Ceftriaxone given as an intramuscular dose targets gonorrhea effectively. Adding azithromycin as a single large oral dose covers chlamydia and simplifies adherence, making it a practical option in adolescents who may have difficulty completing a multiday course. This combination is preferred over using an antibiotic alone, which would miss one of the pathogens. Using only azithromycin would leave gonorrhea untreated. Relying on doxycycline alone would address chlamydia but not gonorrhea. Erythromycin is not effective enough for these sexually transmitted infections and is not recommended as first-line therapy.

If someone has gonorrhea with a high likelihood of concurrent chlamydia, the best approach is dual therapy that directly treats both infections in a single visit. Gonorrhea has shown resistance to many antibiotics, so the recommended regimen includes an injectable cephalosporin to reliably cover Neisseria gonorrhoeae. Pairing that with a single-dose agent that covers Chlamydia trachomatis ensures both infections are treated at once, reducing the chance of ongoing infection and transmission.

Ceftriaxone given as an intramuscular dose targets gonorrhea effectively. Adding azithromycin as a single large oral dose covers chlamydia and simplifies adherence, making it a practical option in adolescents who may have difficulty completing a multiday course. This combination is preferred over using an antibiotic alone, which would miss one of the pathogens.

Using only azithromycin would leave gonorrhea untreated. Relying on doxycycline alone would address chlamydia but not gonorrhea. Erythromycin is not effective enough for these sexually transmitted infections and is not recommended as first-line therapy.