Question 1: A patient with multiple sexual exposures is diagnosed with gonorrhea. What is the appropriate treatment?
- A. Acyclovir
- B. Cefixime
- C. Doxycycline
- D. Ceftriaxone (Correct Answer)
Explanation: ***Ceftriaxone***
- **Ceftriaxone** is the **first-line recommended treatment** for uncomplicated gonorrhea according to **CDC and WHO guidelines**.
- Administered as a **single intramuscular injection (500 mg IM)**, it provides highly effective coverage against *Neisseria gonorrhoeae* with minimal resistance.
- It works by inhibiting bacterial cell wall synthesis, and is the **gold standard therapy** for gonorrhea treatment.
- For patients with multiple sexual exposures, empiric treatment for co-infection with *Chlamydia trachomatis* (doxycycline) should also be considered.
*Cefixime*
- **Cefixime** was previously used as an oral alternative but is **no longer recommended** as first-line therapy due to **increasing resistance** of *N. gonorrhoeae*.
- The CDC removed cefixime from recommended regimens due to **inferior efficacy** compared to ceftriaxone and concerns about treatment failures.
- While it is an oral cephalosporin, it is **not appropriate first-line therapy** for gonorrhea.
*Doxycycline*
- **Doxycycline** is commonly used to treat **co-infection with *Chlamydia trachomatis***, which frequently occurs alongside gonorrhea.
- The typical regimen is **100 mg twice daily for 7 days** as adjunctive therapy.
- However, doxycycline is **not effective as monotherapy for gonorrhea** and should not be used alone to treat *N. gonorrhoeae* infection.
*Acyclovir*
- **Acyclovir** is an **antiviral medication** used to treat **herpes simplex virus (HSV)** infections.
- It works by inhibiting viral DNA replication and has **no activity against bacterial infections** like gonorrhea.
- It would be completely ineffective against *Neisseria gonorrhoeae*.