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Pelvic Inflammatory Disease — DRCOG MCQ

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ModerateObstetrics & GynecologyPelvic Inflammatory DiseaseDRCOG

A 28-year-old woman with pelvic inflammatory disease (PID) presents with fever, pelvic pain, cervical motion tenderness, and mucopurulent discharge. She is stable for outpatient therapy. What is the best initial treatment regimen?

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Correct answer: A — Ceftriaxone 500 mg IM once plus doxycycline 100 mg BID and metronidazole 500 mg BID for 14 days

For a clinically stable, nonpregnant patient with mild-to-moderate PID who can be treated as an outpatient, the recommended initial empiric regimen is ceftriaxone 500 mg IM once plus doxycycline 100 mg orally twice daily for 14 days plus metronidazole 500 mg orally twice daily for 14 days. This provides broad coverage for Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobes, and organisms associated with bacterial vaginosis. Azithromycin alone, cefixime-based short therapy, levofloxacin monotherapy, and older ceftriaxone 250 mg plus azithromycin regimens are inadequate for PID because they do not provide the recommended breadth and/or duration of treatment.

Reference: CDC Sexually Transmitted Infections Treatment Guidelines: Pelvic Inflammatory Disease, current online guidance based on CDC STI Treatment Guidelines 2021. https://www.cdc.gov/std/treatment-guidelines/pid.htm