A 19 year old female presents to the ED with abnormal vaginal discharge for 5 days. She is sexually active with a new male partner and does not consistently use protection. A pelvic  exam reveals cervicitis. A vaginal GC swab is sent to the lab. Her urine hcg is negative. After discussing your concerns with the patient, she agrees to be empirically treated for GC infection today. She weighs 55 kg. What treatment regimen do you order?

1. Ceftriaxone 500 mg IM once + doxycycline 100 mg PO BID x 7 days

2. Ceftriaxone 250 mg IM once + azithromycin 1 g PO once

3. Ceftriaxone 1 g IM once + azithromycin 1 g PO once

4. Ceftriaxone 1 g IM once + doxycycline 100 mg PO BID x 7 days

Answer: A. The CDC updated their guidelines for GC infection in December 2020. Due to increasing resistance in the community, the recommended empiric GC dosing regimen for patients weighing < 150 kg is 500 mg IM ceftriaxone once (rather than the previous 250 mg) with chlamydia coverage as doxycycline 100 mg PO BID x 7 days. If the patient weighs > 150 kg, the dose of IM ceftriaxone increases to 1 g IM once. If the patient is pregnant, doxycycline is replaced by azithromycin 1 g PO once.