A 16-year-old girl presents with postcoital bleeding for the past week. She has mucopurulent cervical discharge and friable cervix. A pregnancy test is negative. What is the most appropriate treatment?

• A. Intramuscular administration of ceftriaxone 500 mg, and prescription for oral doxycycline 100 mg twice daily for seven days
• B. Oral azithromycin 1 g single dose
• C. Metronidazole alone
• D. Doxycycline alone

Answer: (A)

This scenario tests how to treat cervicitis likely caused by Neisseria gonorrhoeae with possible coinfection by Chlamydia trachomatis. When a sexually active teen presents with friable cervix and mucopurulent discharge, gonorrhea is a top consideration, and chlamydia often accompanies it. Because gonorrhea has developed resistance to many antibiotics, the best initial approach is dual therapy that covers both organisms: administer ceftriaxone by intramuscular injection to treat gonorrhea, and provide doxycycline orally for seven days to cover chlamydia. This combination reduces the risk of ongoing infection and complications like pelvic inflammatory disease. The other options don’t adequately cover both pathogens: metronidazole targets anaerobes and protozoa, not gonorrhea or chlamydia; doxycycline alone misses gonorrhea; azithromycin alone is not as reliable for treating gonorrhea in many guidelines. If pregnancy were a factor, doxycycline would be avoided and an alternative regimen would be used, but in this nonpregnant patient the ceftriaxone plus doxycycline plan is the most appropriate choice.