What is an appropriate initial therapy for gonococcal infection that also covers possible chlamydial coinfection?

• A. Penicillin G
• B. Azithromycin alone
• C. Ceftriaxone 50 mg IM with doxycycline concurrently
• D. Ciprofloxacin

Answer: (C)

Gonorrhea often occurs with a concurrent chlamydial infection, so starting treatment that covers both pathogens at once is the best approach. A cephalosporin that reliably treats Neisseria gonorrhoeae is paired with doxycycline to cover Chlamydia trachomatis, which can be present even if symptoms aren’t obvious. This dual therapy reduces the risk of ongoing infection, complications, and further transmission. Penicillin G is no longer effective against gonorrhea due to resistance, ciprofloxacin is unreliable because of widespread resistance, and azithromycin alone does not adequately treat gonorrhea. So using ceftriaxone with doxycycline concurrently addresses both infections from the outset.