Disseminated gonococcal infection presenting with arthritis: which antibiotic strategy is used if chlamydia has not been excluded?

• A. Ceftriaxone 1 g IV daily plus doxycycline 100 mg PO BID x7 days
• B. Ceftriaxone 1 g IV daily alone
• C. Azithromycin alone
• D. Ciprofloxacin

Answer: (A)

Disseminated gonococcal infection with arthritis is treated with a strong gonorrhea-active antibiotic plus coverage for possible chlamydial coinfection, since chlamydia is common and its status may be unknown. Ceftriaxone given IV daily rapidly and reliably clears Neisseria gonorrhoeae in disseminated disease. Because chlamydia may be present even if not diagnosed, adding doxycycline provides protection against a coexisting chlamydial infection. This combination—ceftriaxone plus doxycycline for about a week—addresses both pathogens and reduces the risk of ongoing infection or joint involvement.

Ceftriaxone alone wouldn’t guard against chlamydia; azithromycin or a fluoroquinolone alone isn’t sufficient for gonorrhea given current resistance patterns. So, in the setting where chlamydia hasn’t been excluded, the dual therapy is the best approach. Partner treatment and appropriate testing are also important components of care.