A 29-year-old man with painful urination and urethral discharge; sexually active with multiple partners in the past 6 months. What is the most appropriate treatment?

• A. Doxycycline
• B. Azithromycin
• C. Ceftriaxone
• D. Metronidazole

Answer: (A)

When a patient presents with painful urination and urethral discharge in the context of multiple sexual partners, you treat empirically for the two most common sexually transmitted pathogens that can cause urethritis: Neisseria gonorrhoeae and Chlamydia trachomatis. The reason is that coinfection is common, and focusing on only one organism can miss the other.

The best approach is to give a regimen that covers both infections: a cephalosporin long trusted to treat gonorrhea (ceftriaxone) to address Neisseria gonorrhoeae, plus an agent active against chlamydia (doxycycline) to cover Chlamydia trachomatis. This dual therapy reduces the risk of ongoing infection and further transmission. Azithromycin can be an alternative for chlamydia if doxycycline is not suitable, but it’s not as reliable for gonorrhea when used alone. Metronidazole would not cover these urogenital pathogens and isn’t appropriate here.

So, the rationale is to address both potential pathogens with a combination that provides effective coverage for gonorrhea and chlamydia, rather than relying on a single agent that might miss one of the infections.