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Pelvic inflammatory disease — MCCQE Part 1 MCQ

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ModeratePelvic PainPelvic inflammatory diseaseMCCQE Part 1

22-year-old woman presents with lower abdominal pain and dyspareunia. She has cervical motion tenderness and mucopurulent discharge. Which of the following is the most appropriate next step?

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Correct answer: A — Treat empirically for PID and test for STIs

Treat empirically for PID and test for STIs is best because cervical motion tenderness with pelvic pain supports PID and treatment should not wait for results. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Delayed treatment increases infertility and ectopic risk.

Reference: Canadian STI Guidelines