Vaginitis, Mucopurulent Cervicitis, and Pelvic Inflammatory Disease

A previously healthy 17-year-old girl is seen in the emergency department with complaints of left lower quadrant abdominal pain, vomiting, and fevers for the last 2 days. She does not have a prior history of urinary tract infections. Her appendix was removed when she was 6 years old. She states that she is sexually active and has had three male partners over the past 3 months, with intermittent condom use. Her temperature is 38 °C, with normal vital signs otherwise. On physical examination, she has tenderness of the left lower quadrant of her abdomen, without rebound or guarding. On pelvic exam, her cervix is friable with motion tenderness. On bimanual exam, she has moderate left adnexal tenderness. Results of laboratory studies include a total white blood cell count of 26,000 cells/μL with 85% neutrophils and 15% lymphocytes, an elevated erythrocyte sedimentation rate, and an elevated C-reactive protein. Swabs of the cervix, taken during the pelvic exam, were sent to the laboratory for a wet mount, KOH prep, and nucleotide acid amplification testing for gonorrhea, chlamydia, and trichomonas. The laboratory calls with positive results for both gonorrhea and chlamydia. A screening blood test for syphilis and a fourth-generation HIV test are negative. The girl is hospitalized for treatment of pelvic inflammatory disease. After 4 days of treatment with intravenous cefoxitin and oral doxycycline, her pain is well-controlled, and she is fever free for 48 hours. Results of a repeat erythrocyte sedimentation rate and C-reactive protein are improved. The girl is discharged home to complete a 14-day course of doxycycline. Her sexual partners are contacted by the local health department and advised to seek medical attention and treatment for chlamydia and gonorrhea.