A 25-year-old woman presents with lower abdominal pain, mucopurulent cervical discharge, and bilateral adnexal tenderness. Nucleic acid amplification test (NAAT) is positive for Neisseria gonorrhoeae. According to 2021 CDC guidelines, the preferred OUTPATIENT treatment regimen is:

• A Ceftriaxone 500 mg IM single dose + doxycycline 100 mg BD × 14 days + metronidazole 500 mg BD × 14 days ✓
• B Ciprofloxacin 500 mg oral single dose + azithromycin 1 g oral single dose
• C Ceftriaxone 250 mg IM single dose + azithromycin 1 g oral single dose
• D Ofloxacin 400 mg BD × 14 days + metronidazole 500 mg BD × 14 days

Explanation

CDC 2021 STI Treatment Guidelines recommend ceftriaxone 500 mg IM single dose (increased from 250 mg due to rising MIC values) + doxycycline 100 mg BD for 14 days + metronidazole 500 mg BD for 14 days as the preferred outpatient PID regimen. Doxycycline covers Chlamydia trachomatis (which frequently co-infects with gonorrhea), and metronidazole covers anaerobes and BV-associated organisms that contribute to PID polymicrobial pathogenesis. Fluoroquinolones (B, D) are no longer recommended for gonorrheal PID due to widespread quinolone resistance in N. gonorrhoeae. Option C uses the older 250 mg ceftriaxone dose without metronidazole, which is now suboptimal per 2021 guidelines.

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

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Written and medically reviewed by the StethoPrep medical team.