A 28-year-old man presents to the clinic for evaluation of painful urination and cloudy-color penile discharge. The symptoms started 2 days ago and are not associated with any other symptoms. His past medical history is not significant and he is not on any medications.His physical examination is completely normal except for a purulent discharge that can be expressed from his penis. A swab of the fluid reveals Gram-negative diplococci within neutrophils. Which of the following is the most appropriate treatment?
This patient has gonorrhea, and since 1986, increasing penicillin resistance has meant that penicillin/ampicillin are no longer drugs of choice. Alternatives to ceftriaxone include ciprofloxacin, ofloxacin, or cefixime given orally, with 7 days of doxycycline, or a single 1 g dose of azithromycin in case of coinfection with Chlamydia. In Asia and the Pacific (as well as in California), quinolones are not considered first-line therapy because of the high rate of resistant organisms. In these locations, ceftriaxone is the drug of choice. In pregnant women, erythromycin replaces doxycycline. Disseminated gonococcal infection should be treated in a hospital with IV antibiotics.
intramuscular ceftriaxone plus oral doxycycline
oral penicillin G
intramuscular penicillin V
intramuscular ampicillin and oral penicillin V
Infection