A 23-year-old woman at 10 weeks of gestation presents with bilateral lower abdominal pain, cervical motion tenderness, and fever of 38.5 degrees Celsius. What is the MOST appropriate next step in management?
- A Outpatient doxycycline plus metronidazole
- B Hospitalisation with parenteral antibiotics active against chlamydia, gonorrhoea and anaerobes ✓
- C Outpatient azithromycin alone with review in 72 hours
- D Immediate laparoscopy and drainage of adnexa
Correct answer: B. Hospitalisation with parenteral antibiotics active against chlamydia, gonorrhoea and anaerobes
Explanation
Pregnancy is an explicit criterion for hospitalisation in PID because outpatient oral regimens are inadequate and doxycycline is contraindicated in pregnancy. Parenteral therapy covering chlamydia, gonorrhoea and anaerobes, using pregnancy-compatible agents such as ceftriaxone or azithromycin with clindamycin, is indicated. Laparoscopy is reserved for failure of medical therapy or diagnostic uncertainty, not as the first step in an uncomplicated antenatal presentation.
Reference: CDC STI Treatment Guidelines, 2021 ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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