American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the empiric therapy for cervicitis and urethritis?

1. Ceftriaxone, 250 mg IM plus doxycycline

2. Azithromycin, 1 g PO plus metronidazole

3. Ceftriaxone, 250 mg IM plus azithromycin

4. Levofloxacin, 500 mg PO daily

The correct answer is: Ceftriaxone, 250 mg IM plus azithromycin

Ceftriaxone paired with azithromycin is considered the standard empiric therapy for cervicitis and urethritis due to its effectiveness against the most common pathogens responsible for these conditions, particularly Neisseria gonorrhoeae and Chlamydia trachomatis. Ceftriaxone, as a broad-spectrum cephalosporin antibiotic, provides strong coverage against gonococcal infections, which are often implicated in cervicitis and urethritis. Azithromycin is included to ensure adequate coverage for chlamydial infections, which are frequently co-infected with gonorrhea. This dual therapy is crucial not only for treating existing infections but also for mitigating the risk of antibiotic resistance, particularly in cases of gonorrhea. While other options involve different antibiotics, they do not adequately target the common pathogens of cervicitis and urethritis as effectively as the combination of ceftriaxone and azithromycin. For instance, doxycycline can treat Chlamydia but does not sufficiently address gonorrhea when used alone. Therefore, the combination therapy of ceftriaxone and azithromycin represents the current best practice in empiric treatment for these conditions.