A 22-year-old woman with PID develops a 5 cm tubo-ovarian abscess confirmed on ultrasound. She is admitted and started on IV cefoxitin and doxycycline. After 72 hours of antibiotics, she remains febrile with increasing pelvic pain. The NEXT management step is:

• A Add IV metronidazole to existing regimen
• B Change to broad-spectrum oral antibiotics and discharge
• C Emergency exploratory laparotomy with bilateral salpingo-oophorectomy
• D Ultrasound-guided aspiration or laparoscopic drainage ✓

Explanation

Tubo-ovarian abscesses that fail to respond clinically within 48–72 hours of IV antibiotics require drainage. Ultrasound-guided (transvaginal or transabdominal) aspiration or laparoscopic drainage is the minimally invasive next step, achieving drainage and reducing antibiotic failure. Radical surgery (bilateral salpingo-oophorectomy) is reserved for ruptured or non-drainable abscesses with clinical deterioration. Metronidazole may already be included in the regimen but alone is insufficient for a persistent abscess.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.