A 25-year-old woman presents with pelvic pain, cervical motion tenderness, and purulent cervical discharge. She has a pelvic ultrasound showing bilateral adnexal masses with thick walls and internal echoes consistent with tubo-ovarian abscesses (TOA) measuring 5 cm on each side. She is afebrile and haemodynamically stable. According to CDC 2021 PID treatment guidelines, which is the most appropriate initial management?

• A Immediate laparoscopic drainage of TOA as outpatient antibiotics are inadequate for abscesses ≥4 cm
• B IV Cefoxitin 2g q6h + IV Doxycycline 100 mg q12h until clinical improvement, then oral Doxycycline + Metronidazole to complete 14 days ✓
• C Oral Doxycycline 100 mg BD + Metronidazole 400 mg BD for 14 days as outpatient management is appropriate
• D IV Ampicillin-sulbactam 3g q6h as single-agent therapy for polymicrobial TOA

Explanation

CDC 2021 STI treatment guidelines recommend hospitalisation for TOA (regardless of size) due to risk of rupture, need for IV antibiotics, and surgical intervention if no response. The recommended inpatient regimen is: IV Cefoxitin 2g q6h (or Cefotetan 2g q12h) PLUS IV/oral Doxycycline 100 mg q12h — continued until 24 hours after clinical improvement, then transition to oral doxycycline 100 mg BD + metronidazole 500 mg BD to complete 14 days. Outpatient oral therapy is not appropriate for TOA. Surgical/radiological drainage is reserved for TOA that fails to respond to 72 hours of IV antibiotics.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.