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Urethritis empiric therapy — MRCGP AKT MCQ

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EasyInfectious DiseasesUrethritis empiric therapyMRCGP AKTUKMLAPARAPSA

A 26-year-old man presents with dysuria and profuse purulent urethral discharge. His regular sexual partner has tested positive for both Neisseria gonorrhoeae and Chlamydia trachomatis. He has no relevant drug allergies. First-catch urine for NAAT and a urethral specimen for gonococcal culture have been obtained, but same-day assessment by the local sexual health service is unavailable. What is the most appropriate immediate antimicrobial treatment?

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Correct answer: A — Give ceftriaxone 1 g intramuscularly once plus doxycycline 100 mg twice daily for 7 days

The correct answer is A. He has symptomatic urethritis and documented exposure to both gonorrhoea and chlamydia, so treatment should not be delayed after appropriate NAAT and gonococcal culture specimens have been obtained. Ceftriaxone 1 g IM treats gonorrhoea; doxycycline 100 mg twice daily for 7 days treats concurrent chlamydia or non-gonococcal urethritis. Amoxicillin is unreliable because gonococcal resistance is common, while metronidazole alone does not cover either infection. Abstinence advice is essential but is not a substitute for antibiotics. Sexual-health follow-up should be arranged for partner notification, screening for other STIs and gonorrhoea test-of-cure arrangements.

Reference: NHS Greater Glasgow and Clyde, Management of Infection Guidance for Adults, urethritis section, current online version accessed 2026: https://www.rightdecisions.scot.nhs.uk/media/2583/166-inf-mng-adults-fp.pdf