What is the recommended empiric therapy for coinfection with gonorrhea and chlamydia in adults?

• A. Ceftriaxone plus doxycycline (or azithromycin if doxycycline contraindicated)
• B. Penicillin V alone
• C. Azithromycin monotherapy
• D. Doxycycline monotherapy

Answer: (A)

When coinfection with gonorrhea and chlamydia is suspected, you treat for both infections at the same time. Gonorrhea is best covered with ceftriaxone, a cephalosporin that remains effective against Neisseria gonorrhoeae, while chlamydia is targeted with doxycycline. Therefore, the recommended empiric regimen for adults is ceftriaxone plus doxycycline to address both pathogens. If doxycycline cannot be used, azithromycin 1 g can substitute for the chlamydia component. Doxycycline or azithromycin alone would miss gonorrhea, and penicillin V alone is not reliable for gonorrhea due to resistance, so dual therapy is essential to prevent persistent infection and complications. Also, ensure partner notification and testing for other STIs.