For cervicitis with mucopurulent discharge and friable cervix in a young patient, what is the recommended outpatient regimen to treat gonorrhea with possible chlamydial co-infection?

• A. Oral azithromycin 1 g single dose
• B. Intramuscular ceftriaxone 500 mg plus doxycycline 100 mg twice daily for seven days
• C. Cefixime monotherapy
• D. Metronidazole plus fluconazole

Answer: (B)

The main idea is using a regimen that reliably clears gonorrhea while also treating a common co-infection with Chlamydia trachomatis in outpatient cervicitis. Neisseria gonorrhoeae is best tackled with a cephalosporin that remains highly effective in current practice, and Chlamydia coverage is added because co-infection is common in young patients with cervicitis.

Ceftriaxone 500 mg given by intramuscular injection in a single dose provides strong, rapid activity against gonorrhea and has become the preferred outpatient treatment due to rising resistance to other oral options. Because Chlamydia is frequently present alongside gonorrhea, adding doxycycline 100 mg by mouth twice daily for seven days ensures adequate treatment of the intracellular pathogen. This dual approach addresses both infections in one visit, reduces the risk of pelvic inflammatory disease, and helps limit transmission.

alternatives fall short: a single-dose azithromycin alone wouldn’t reliably eradicate gonorrhea, cefixime monotherapy has less favorable activity against current gonorrhea strains and doesn’t adequately cover Chlamydia, and metronidazole plus fluconazole targets vaginal flora or yeast rather than gonorrhea or Chlamydia.