An 18-Year-Old Woman Comes to the Office for Evaluation of Dysuria

question 1043

Multiple Choice

An 18-year-old woman comes to the office for evaluation of dysuria that began 8 days ago.  The patient went to urgent care a week ago and completed a 7-day course of nitrofurantoin with no relief of symptoms.  She also has vaginal discharge but no fever, chills, or back pain.  The patient is monogamous with a male partner and takes combination estrogen/progestin oral contraceptives.  She has no chronic medical conditions or medication allergies.  Temperature is 36.7 C (98.1 F) , blood pressure is 118/74 mm Hg, and pulse is 68/min.  On speculum examination, there is thick, yellow cervical discharge, and the cervix bleeds on contact with a swab.  No pain is present on bimanual pelvic examination.  The remainder of the examination is normal.  Wet mount microscopy shows multiple leukocytes but no clue cells or motile organisms.  Urinalysis is positive for leukocyte esterase but negative for nitrites and blood.  Urine pregnancy testing is negative.  Cervical swabs are obtained for further testing.  Which of the following is the best next step in management of this patient?

• A)Azithromycin and doxycycline
• B)Ceftriaxone and doxycycline
• C)Clindamycin and gentamicin
• D)No treatment indicated until tests results are available
• E)Trimethoprim-sulfamethoxazole

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