Gonorrhoea — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSTIsGonorrhoeaSCE Infectious Diseases

A 38-year-old HIV-positive MSM (CD4 450, VL <50 on ART) presents with acute proctitis. Rectal NAAT is positive for Neisseria gonorrhoeae. Antimicrobial susceptibility testing reveals Ceftriaxone MIC 0.5 mg/L (susceptible but approaching the breakpoint) and Ciprofloxacin resistance. What is the recommended treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Ceftriaxone 1 g IM single dose; test of cure at 2 weeks is essential

BASHH 2024 guidelines recommend Ceftriaxone 1 g IM as first-line for gonorrhoea at all sites. With an MIC of 0.5 mg/L (susceptible but elevated), a test of cure (TOC) at 2 weeks by NAAT is particularly important to confirm microbiological clearance. Any treatment failure should be reported to UKHSA. Ciprofloxacin resistance precludes its use. Azithromycin monotherapy is no longer recommended due to rising resistance. Spectinomycin is an alternative but has limited availability in the UK.

Reference: BASHH 2019 (updated 2024) – Gonorrhoea guidelines; UKHSA 2024 – GRASP surveillance