For complicated gonococcal infection, what regimen is recommended when NAAT is positive for Chlamydia?

• A. IV ceftriaxone + doxycycline
• B. IM ceftriaxone alone
• C. Oral doxycycline only
• D. IV vancomycin

Answer: (A)

The main idea is that when gonorrhea is complicated and there is a concurrent Chlamydia infection (as shown by a positive NAAT), the treatment must cover both organisms. Complicated gonococcal infection requires an IV antibiotic to ensure adequate drug levels and control systemic or deep-seated infection, which is provided by IV ceftriaxone. Because Chlamydia trachomatis is intracellular and commonly co-occurs with gonorrhea, adding doxycycline covers this co-infection effectively. Therefore, a regimen combining IV ceftriaxone to treat the gonorrhea with doxycycline to treat the Chlamydia is the best choice. The other options either miss treating gonorrhea adequately (oral doxycycline alone) or omit coverage for Chlamydia (ceftriaxone alone), or use an antibiotic (vancomycin) that isn’t active against these sexually transmitted pathogens.