This week’s free board review question…
A 22-year-old woman presents with vaginal discharge that she has had for several weeks. On examination, you note purulent discharge from the os of the cervix and a friable cervix. She is minimally tender on bimanual examination, is not febrile, and she has a normal white blood cell count. You collect swabs of the discharge to test for chlamydia and gonorrhea infections. Immediate microscopy does not show evidence of Trichomonas species, bacterial vaginosis, or yeast.
Which of the following is the next best step in the management of this patient’s symptoms?
administer intravenous antibiotics for presumed pelvic inflammatory disease
prescribe oral ciprofloxacin 500 mg twice a day for 7 days and oral doxycycline 100 mg twice a day for 7 days to take only if the test results are positive for chlamydia and/or gonorrhea infection
administer ceftriaxone 250 mg intramuscular and oral azithromycin 1 g empirically
collect a swab of the discharge for Gram stain
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