What is the recommended empiric therapy for gonorrhea with coinfection risk?

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

Answer: (B)

When there’s suspected gonorrhea with a risk of coinfection, you treat for both infections right away. Coinfection with gonorrhea and Chlamydia trachomatis is common, and gonorrhea has developed resistance to many older antibiotics, so the empiric plan must cover both organisms.

Ceftriaxone is a powerful third-generation cephalosporin that reliably treats Neisseria gonorrhoeae and works well in the common sites of infection. Adding doxycycline targets Chlamydia trachomatis, providing broad coverage for the likely coinfection. This dual therapy reduces the chance of persistent infection and transmission.

Other options fall short for this scenario: fluoroquinolone resistance makes ciprofloxacin ineffective against gonorrhea; penicillin G is no longer reliable due to widespread resistance; azithromycin alone won’t treat gonorrhea adequately.