American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the first-line treatment for gonococcal cervicitis or urethritis?

Clindamycin, 900 mg IM
Ceftriaxone, 250 mg IM plus azithromycin
Azithromycin, 1 g PO
Doxycycline, 100 mg PO daily

The correct answer is: Ceftriaxone, 250 mg IM plus azithromycin

The first-line treatment for gonococcal cervicitis or urethritis is a combination of ceftriaxone and azithromycin. This regimen is particularly effective due to the rise of antibiotic resistance in Neisseria gonorrhoeae, the bacteria responsible for gonococcal infections. Ceftriaxone, administered via intramuscular injection, is a broad-spectrum cephalosporin that works by inhibiting bacterial cell wall synthesis, effectively targeting the gonococcus. The addition of azithromycin, an oral macrolide, provides concurrent treatment against potential co-infection with Chlamydia trachomatis and helps to cover any possible resistance exhibited by the gonococcus to single therapies. Current guidelines recommend this dual therapy approach to enhance effectiveness and reduce the likelihood of treatment failure due to resistance patterns. The use of a single agent alone, such as clindamycin or doxycycline, does not provide adequate coverage for gonorrhea specifically, making this combination the optimal first-line treatment.