A 25-year-old presents with 5 days of lower abdominal pain, cervical motion tenderness, and mucopurulent cervical discharge. Temperature 38.2°C, WBC 14,000/µL. Transvaginal ultrasound shows bilateral adnexal thickening but no abscess. Per CDC 2021 guidelines, which outpatient treatment regimen is appropriate for PID?
- A Single-dose azithromycin 1g + doxycycline 100 mg BD for 14 days
- B Ceftriaxone 500 mg IM single dose + doxycycline 100 mg BD for 14 days + metronidazole 500 mg BD for 14 days ✓
- C Amoxicillin-clavulanate 875 mg BD for 14 days + metronidazole 500 mg BD
- D Ciprofloxacin 500 mg BD for 14 days + metronidazole 500 mg BD for 14 days
Explanation
CDC 2021 STI Treatment Guidelines for outpatient PID management recommend: Ceftriaxone 500 mg IM single dose (1g if weight ≥ 150 kg) PLUS doxycycline 100 mg orally twice daily for 14 days WITH metronidazole 500 mg orally twice daily for 14 days. The ceftriaxone covers gonorrhoeal and other gram-negative organisms; doxycycline covers Chlamydia and other pathogens; metronidazole addresses anaerobes important in upper genital tract infection. Fluoroquinolones (ciprofloxacin) are no longer recommended due to high Neisseria gonorrhoeae resistance rates. Amoxicillin-clavulanate does not provide adequate anti-chlamydial coverage.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.