First-line therapy for Neisseria gonorrhoeae infection with coverage for possible Chlamydia co-infection?

• A. Penicillin G
• B. Ceftriaxone plus doxycycline
• C. Ceftriaxone alone
• D. Azithromycin alone

Answer: (B)

Gonorrhea is treated with a cephalosporin because of rising resistance, and we also want to cover a common coinfection with Chlamydia. Ceftriaxone reliably kills Neisseria gonorrhoeae, and adding doxycycline provides coverage for Chlamydia trachomatis, which often accompanies gonorrhea and can lead to pelvic inflammatory disease and other complications if not treated. Penicillin G is no longer effective against gonorrhea due to widespread resistance, so it’s not suitable. Ceftriaxone alone would miss a possible chlamydial coinfection, and azithromycin alone wouldn’t reliably treat gonorrhea given resistance concerns. So pairing ceftriaxone with doxycycline addresses both infections in one regimen.