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INTERNATIONAL LEARNING PLAN - DAY 66
1/27
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A 24-year-old woman comes to the physici
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0h 00m
SESSION
00:21
QUESTION

SEE ANALYSIS
A 24-year-old woman comes to the physician because of a 3-day history of lower abdominal pain and dysuria. She has a history of recurrent urinary tract infections that have resolved with antibiotic treatment. She is sexually active with one male partner, and they do not use condoms. She had mild pain during her last sexual intercourse 1 week ago. Her temperature is 38.2°C (100.8°F), pulse is 86/min, and blood pressure is 110/70 mm Hg. Physical examination shows lower abdominal tenderness and bilateral inguinal lymphadenopathy. There is a small amount of purulent vaginal discharge. Bimanual examination shows uterine and cervical motion tenderness. Laboratory studies show:

Hemoglobin	12 g/dL
Leukocyte count	13,500/mm3
Segmented neutrophils	75%
Eosinophils	1%
Lymphocytes	22%
Monocytes	2%
Platelet count	328,000/mm3
Erythrocyte sedimentation rate	82 mm/h
Urine	
RBC	1–2/hpf
WBC	0–1/hpf
Nitrite	negative
Bacteria	occasional
Urine pregnancy test	negative
Which of the following is the most appropriate pharmacotherapy?

KEY INFO

ATTENDING TIP

LABS

SAVE

FEEDBACK

The onset of lower abdominal pain, dysuria, dyspareunia, and vaginal discharge, along with physical findings such as uterine tenderness in a sexually active woman, are highly suggestive of pelvic inflammatory disease (PID).

FEEDBACK
Oral metronidazole

4%
Oral doxycycline

4%
Doxycycline is recommended for the treatment of PID, as it covers Chlamydia trachomatis, one of the most common pathogens. However, PID commonly involves multiple bacteria, and doxycycline does not cover N. gonorrhoeae, which is an even more common cause of PID than Chlamydia trachomatis.

FEEDBACK
Intramuscular leuprolide

0%
Oral levofloxacin and azithromycin

5%
Oral trimethoprim-sulfamethoxazole

3%
Oral nitrofurantoin

2%
Intramuscular ceftriaxone and oral doxycycline

81%
Combination therapy with intramuscular ceftriaxone and oral doxycycline is the first-line treatment for PID, which requires combination therapy because it is often caused by multiple bacteria. The two most commonly isolated pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis. Ceftriaxone is used for its effectiveness against N. gonorrhoeae, while doxycycline provides coverage of C. trachomatis. In addition, metronidazole may be included with this regimen for anaerobic coverage.

Answer 1

% answer