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A 28-year-old woman comes to your clinic for vaginal discharge and dyspareunia. Her last pelvic exam and Pap smear six years ago were normal. Her only medication is oral contraceptives. She is sexually active with one partner and denies a history of sexually transmitted diseases. Examination of the pelvis reveals a mucopurulent, nonodorous, whitish discharge at the endocervical os. The cervix appears edematous and erythematous with minimal bleeding noted with scraping. What is the next appropriate step in the management of this patient?
(A) Doxycycline
(B) Azithromycin and ceftriaxone
© Metronidazole
(D) Wait for culture and immunofluorescence testing results
(E) Azithromycin
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darkhorse
isnt edematous and erythematous Cx-- strawberry cervix indicates trichomonas
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i thought trichomonas produces frthy and greenish discharge....u r right about strawberry cervix.....but again mucopurulent discharge will be classical of chlamydia.....so thats y i thought .bbbbb...may be u r right
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Answer:
(B) Azithromycin and ceftriaxone
Explanation:
This patient presents with cervicitis and a mucopurulent discharge found on pelvic exam. The presence of white blood cells is also often found on endocervical Gram stain, which would also support the diagnosis. This is too nonspecific to be useful in guiding the choice of a single specific therapy. All forms of cervicitis will give white cells on a Gram stain of the cervix. Edema of the cervix with the propensity of the mucosa to bleed on minor trauma is common with cervicitis. These findings are commonly found in association with both chlamydial and gonococcal infection. Empiric therapy for both diseases is indicated. You can't just treat the chlamydia. This patient has a clear diagnosis of cervicitis because of the discharge and dyspareunia, combined with a cervical discharge. Chlamydia can be treated either with a single dose of azithromycin or with doxycycline for a week in those patients with cervicitis or urethritis. Gonorrhea can be treated with a single dose of ceftriaxone, cefixime, or a fluoroquinolone, such as ciprofloxacin, levofloxacin, or ofloxacin. The quinolones are associated with more resistance than the cephalosporins.
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B) Azithromycin and ceftriaxone
