A 21-year-old man comes to the physician due to penile discharge. He has had a discomfort during urination for several days with no fever or hematuria. He has no prior medical conditions and takes no medications. On genitourinary examination, mucopurulent discharge is noted at the urethral meatus. Microscopy of the discharge shows numerous neutrophils, some of which contain intracellular gram-negative diplococci. He is given an intramuscular injection of ceftriaxone. Which of the following additional medications is recommended at this time?

Question

A 21-year-old man comes to the physician due to penile discharge. He has had a discomfort during urination for several days with no fever or hematuria. He has no prior medical conditions and takes no medications. On genitourinary examination, mucopurulent discharge is noted at the urethral meatus.  Microscopy of the discharge shows numerous neutrophils, some of which contain intracellular gram-negative diplococci. He is given an intramuscular injection of ceftriaxone.  Which of the following additional medications is recommended at this time?

Quizplus · Accepted Answer

Eductional Objective: Urethritis is an inflammation of the urethral mucosa that may be caused by various pathogens, most notably C. trachomatis, N. gonorrhea, and M. genitalium. Treatment for gonococcal urethritis with uncertain or positive Chlamydia coinfection status is ceftriaxone plus doxycycline.  Patients with no gonorrhea who have Chlamydia are treated with azithromycin or doxycycline monotherapy.

A 21-Year-Old Man Comes to the Physician Due to Penile