American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for epididymitis?

1. Ceftriaxone, 250 mg IM plus azithromycin

2. Ceftriaxone, 250 mg IM plus doxycycline

3. Azithromycin, 1 g PO plus doxycycline

4. Levofloxacin, 500 mg PO plus doxycycline

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

The recommended treatment for epididymitis, particularly in adults who are at risk for sexually transmitted infections, typically involves a combination of antibiotics that target the most common pathogens, such as Neisseria gonorrhoeae and Chlamydia trachomatis. In this case, the combination of ceftriaxone and doxycycline effectively covers these organisms. Ceftriaxone is a broad-spectrum cephalosporin antibiotic that is particularly effective against Neisseria gonorrhoeae, while doxycycline is effective against Chlamydia trachomatis. The combination of these two agents provides a dual coverage that is critical in treating epididymitis due to sexually transmitted infections. While other combinations may also be used in certain contexts, the ceftriaxone plus doxycycline regimen is widely supported by clinical guidelines for empirical treatment of epididymitis, especially in sexually active young men. This approach promotes effective management of the infection and helps prevent complications associated with untreated epididymitis.