A 27-year-old woman with an intrauterine contraceptive device in place develops mild PID with cervical motion tenderness and low-grade fever. She is started on oral ceftriaxone plus doxycycline with metronidazole. At review after 72 hours she is afebrile and clinically improved. Per CDC 2021 guidance, the device should be:
- A Removed immediately before continuing antibiotics
- B Left in place while she completes antibiotic treatment, given clinical improvement ✓
- C Replaced with a copper device after finishing treatment
- D Left in place only if repeat endometrial biopsy shows no plasma cells
Correct answer: B. Left in place while she completes antibiotic treatment, given clinical improvement
Explanation
CDC 2021 guidance states that an IUD may remain in situ during PID treatment provided the patient shows clinical improvement, and removal is considered only when there is no response within 48 to 72 hours. Routine removal of an improving patient's IUD deprives her of effective contraception without therapeutic benefit, and histological confirmation is not a prerequisite for retaining the device.
Reference: CDC Sexually Transmitted Infections Treatment Guidelines, 2021 ed.
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Written and medically reviewed by the StethoPrep medical team.