STIs & PID
PID High-yield Verified · Sep 2026Pelvic inflammatory disease is an infectious inflammation of the upper genital tract in females, affecting the uterus, fallopian tubes and ovaries. It is a complication of untreated cervical infection rather than a separate infection.
The disorder behind doxycycline first-line except in pregnancy, behind the ceftriaxone dose that changes at 150 kg, behind one penicillin injection versus three, behind the IUD that stays in, and behind the fetal monitor that goes on after the first syphilis dose.
What’s going wrong in the body
The normal physiology, where it fails, and why the body’s compensation backfires.
01 PID is not an infection — it is a cervical infection that climbed
Pelvic inflammatory disease is "an infectious inflammation of the upper genital tract in females" affecting "the uterus, fallopian tubes, and ovaries." The mechanism explains why it is preventable: "cervical infections disrupt the normal cervical barrier, including the mucosal innate immune system, between the vagina and upper genital tract, leading to infection of these typically sterile organs." PID is what an untreated cervical sexually transmitted infection becomes. The organisms are named with their shares: "the majority of pelvic inflammatory disease cases are caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium; bacterial vaginosis is also common," and the seated guideline gives the practical scale of it: approximately half of patients with pelvic inflammatory disease test positive for one of those two organisms, which is both the argument for treating presumptively and the reason a negative test does not exclude the diagnosis.
The ascent has an anatomical logic and a set of named endpoints. Cervicitis breaches the barrier; infection reaches the endometrium, then the tubes, then the peritoneum, producing endometritis, salpingitis and peritonitis. Tubal scarring is the permanent damage, and it produces three separate harms — infertility, ectopic pregnancy and chronic pelvic pain. The tube's cilia and smooth-muscle transport are what move an embryo to the uterus; scarring strands it, which is why an ectopic pregnancy page exists downstream of this one.
Tubo-ovarian abscess is the complication that changes the plan, because it is a named hospitalization criterion in its own right and, when it is large or ruptures or the patient becomes septic, a surgical one. The infection can also track upward out of the pelvis entirely, which is why a patient with pelvic inflammatory disease and upper abdominal pain is not automatically two problems: "If the inflammation extends to the liver capsule, patients can develop a perihepatitis, known as Fitz-Hugh-Curtis syndrome, which can cause pleuritic pain in the right upper quadrant that radiates to the right shoulder." And the abscess is common enough to look for every time: "Tubo-ovarian abscess develops in 15% to 35% of patients with pelvic inflammatory disease and may require surgical intervention in addition to standard antibiotic regimens."
02 Syphilis — a time boundary decides the treatment
The stages are defined by the Centers for Disease Control and Prevention. Primary is a "single painless ulcer or chancre at the site of infection but can also present with multiple, atypical, or painful lesions." Secondary is "skin rash, mucocutaneous lesions, and lymphadenopathy." Early latent is asymptomatic infection "acquired within the preceding year." Late latent is everything else latent, "or latent syphilis of unknown duration." Tertiary is "cardiac involvement, gummatous lesions, tabes dorsalis, and general paresis."
Two classification points are routinely taught wrong. First, the early-versus-late latent split is a time boundary at one year, not a symptom boundary — and it decides whether the patient gets one penicillin injection or three. Second, neurosyphilis is not "tertiary syphilis." The guideline states plainly that it "can occur at any stage," early "within the first few months or years" and late "10 to >30 years after infection." A patient with a fresh chancre can have neurosyphilis.
Why a painless ulcer is dangerous is itself the mechanism of the disease's spread: because the chancre does not hurt, it is not brought to care, it heals on its own, and the infection proceeds to secondary and latent stages in a patient who believes the problem resolved. In pregnancy the consequence is fetal. Treponemes cross the placenta, "Worse outcomes (prematurity, spontaneous abortion, stillbirths, and perinatal demise) in neonates with congenital syphilis are associated with early transmission of T pallidum to the fetus from the mother during the first trimester," and among untreated maternal syphilis "up to 40% of pregnant women with syphilis will give birth to stillborn neonates, and 33% will deliver infants of low birth weight." Congenital syphilis in the United States has increased more than tenfold between 2012 and 2022, fastest in women under 24. And the newborn gives no warning: 70% of babies born with the disease are asymptomatic at birth, so the cue is the maternal serology, not the baby's appearance.
03 Screening, not symptoms — and the treatment rules that changed in 2021
The intervention that changes outcomes on this page is screening. The US Preventive Services Task Force, in its September 2021 statement, gives a Grade B recommendation to screen sexually active women "if they are 24 years or younger" or "25 years or older and at increased risk," for chlamydia and gonorrhea separately — and the recommendation explicitly includes pregnant persons. For men it issues a Grade I statement: the evidence is insufficient. There is no fixed interval; "a reasonable approach would be to screen patients whose sexual history reveals new or persistent risk factors since the last negative test result." The CDC line matches: annual screening of all sexually active women under 25.
Two regimen changes from 2021 are still being taught the old way. For chlamydia, doxycycline replaced azithromycin as first-line — doxycycline is what a non-pregnant patient receives. But in pregnancy the order inverts, and the reason is a class property rather than a preference: tetracyclines are avoided in pregnancy, so the pregnancy regimen for chlamydia is a macrolide instead. The non-pregnant regimen is "Doxycycline 100 mg orally 2 times/day for 7 days"; the which-patient inversion is the exam item, and the pregnancy dose belongs to the macrolide class page. For gonorrhea, it is ceftriaxone 500 mg IM "in a single dose for persons weighing <150 kg" and 1 g at 150 kg or more — no longer 250 mg, and no longer paired routinely with azithromycin. Doxycycline is added only when chlamydia has not been excluded. Test of cure depends on the site: it "is unnecessary for persons who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea," but "Any person with pharyngeal gonorrhea should return 7–14 days after initial treatment for a test of cure."
The newest recommendation on the page is doxycycline post-exposure prophylaxis, from the CDC's 2024 guideline: 200 mg of doxycycline taken as soon as possible within 72 hours after oral, vaginal or anal sex, to a maximum of 200 mg every 24 hours. It reduces chlamydia by more than 70%, syphilis by more than 70% and gonorrhea by approximately 50%. Its limit is explicit and must travel with it: counselling is directed at "all gay, bisexual, and other men who have sex with men (MSM) and transgender women (TGW)" with a history of at least one bacterial STI — "(specifically, syphilis, chlamydia or gonorrhea) during the past 12 months," and "no recommendation can be given at this time on the use of doxy PEP for cisgender women, cisgender heterosexual men, transgender men, and other queer and nonbinary persons."
04 Treating PID — a deliberately low threshold and a 72-hour clock
CDC sets the diagnostic bar low on purpose. The minimum criteria are "cervical motion tenderness, uterine tenderness, or adnexal tenderness" on pelvic examination in a sexually active woman with pelvic or lower abdominal pain. Note the "or": one of the three suffices. Requiring all three would delay treatment of exactly the tubal damage the guideline exists to prevent. Supportive criteria add weight without being required: oral temperature above 38.3 °C (101 °F), mucopurulent cervical discharge or cervical friability, abundant white cells on saline microscopy, elevated erythrocyte sedimentation rate or C-reactive protein, and documented cervical gonorrhea or chlamydia. The most specific criteria are endometrial biopsy showing endometritis, imaging showing thickened fluid-filled tubes, or laparoscopic findings.
The outpatient regimen is three drugs, not one: ceftriaxone 500 mg IM in a single dose plus "Doxycycline 100 mg orally 2 times/day for 14 days with metronidazole 500 mg orally 2 times/day for 14 days" — the ceftriaxone rising to 1 g above 150 kg with documented gonorrhea. The parenteral regimen is ceftriaxone 1 g intravenously every 24 hours with doxycycline and metronidazole; cefotetan, cefoxitin and a clindamycin-plus-gentamicin option are the listed alternatives, and their doses belong to the class pages. Step-down continues oral doxycycline and metronidazole to a total 14-day course counted from the start, not from the step-down.
Two rules then govern the admission, and both are counterintuitive. Hospitalize when "Surgical emergencies (e.g., appendicitis) cannot be excluded," for tubo-ovarian abscess, for pregnancy, for "Severe illness, nausea and vomiting, or oral temperature >38.5°C (101°F)," when the patient is "Unable to follow or tolerate an outpatient oral regimen," or when there is "No clinical response to oral antimicrobial therapy." Note that pregnancy alone is an admission criterion, and that the admission fever number (38.5 °C) is different from the supportive-criterion fever number (38.3 °C). And the IUD stays in: "if an IUD user receives a diagnosis of PID, the IUD does not need to be removed" — removal is considered only "if no clinical improvement occurs within 48–72 hours." Follow-up is a hard clock: patients "should demonstrate clinical improvement… <3 days after therapy initiation," and failure to improve by 72 hours means hospitalization, regimen reassessment and additional diagnostics.
Causes & risk factors
Modifiable factors are teaching targets — the patient can act on them.
Signs & symptoms
Each finding tied to the mechanism that produces it — and the triage it calls for.
Diagnostics
Complications
Medications for this condition
Why each class is prescribed here — every card links to its full pharmacology page.
Penicillin G is first-line for syphilis — that is what the first-line chip on this class refers to — and it is irreplaceable at every stage — quoted: "Penicillin G, administered parenterally, is the preferred drug for treating patients in all stages of syphilis." The disorder-side reason is that Treponema pallidum has never developed penicillin resistance, and the long-acting benzathine formulation maintains treponemicidal levels across the organism's very slow division time, which is why the late-latent course is spaced at weekly intervals. The staging principle is the exam item, and the figures are the lesson: benzathine penicillin G 2.4 million units intramuscularly as a single dose for primary, secondary and early latent syphilis; 7.2 million units total, as three doses of 2.4 million units one week apart, for late latent or latent of unknown duration. The one-year boundary between early and late latent is what moves a patient from one injection to three, which is why an unrecalled chancre costs two extra visits. A missed dose has a stated tolerance in the guideline's latent-syphilis section — 7 to 9 days between doses is preferred and 10 to 14 days is the outer limit, beyond which the sequence restarts. The unit doses belong to the class page. In pregnancy there is no second option: "parenteral penicillin G is the only therapy with documented efficacy for syphilis during pregnancy," and pregnant patients with penicillin allergy "should be desensitized and treated with penicillin." That is the clearest no-alternative statement in the entire guideline, and it is why maternal syphilis patients "should receive the highest priority if penicillin supplies are low." Amoxicillin has one narrow role here — an alternative for chlamydia in pregnancy, where the tetracycline that would otherwise be first-line cannot be used. The regimen belongs to the class page. Allergy cross-reactivity, desensitization mechanics and general penicillin pharmacology belong to the class page.
Doxycycline has four roles and one hard exclusion on this page, which makes it the drug most worth learning as a set. The first-line chip on this class refers to chlamydia outside pregnancy. First, it became first-line for chlamydia in the 2021 guidelines, displacing azithromycin to alternative status. Second, it is in every PID regimen CDC recommends: 100 mg orally twice daily for 14 days in the outpatient regimen, and 100 mg orally or intravenously every 12 hours in the parenteral ones, continuing through the step-down to a total 14-day course counted from the start. Third, it is the penicillin-allergy alternative for syphilis in non-pregnant patients — 100 mg twice daily for 14 days in primary and secondary disease, and for 28 days in late latent. Fourth, it is the drug in doxy-PEP — 200 mg within 72 hours of sex. The exclusion: doxycycline is not the chlamydia regimen in pregnancy, where a macrolide is used instead. Getting that inversion backwards is the commonest wrong answer on this material, and it is a two-part error, because doxycycline is a pregnancy-avoided drug and is also not what the guideline recommends. It is also, for the same reason, not an option for a penicillin-allergic pregnant patient with syphilis. Tetracycline pharmacology, photosensitivity and chelation interactions belong to the class page.
Ceftriaxone is the backbone of both gonorrhea and pelvic inflammatory disease treatment — those are the two infections the first-line chip on this class refers to — and its dose is weight-dependent in two different places. The rule is an administration rule, and it holds wherever ceftriaxone is given in this treatment context: "Ceftriaxone 500 mg IM in a single dose" for persons weighing under 150 kg, and "1 g of ceftriaxone should be administered" for persons weighing 150 kg or more. Both the number and the weight threshold changed from older teaching, and both are tested. In the outpatient PID regimen it is 500 mg IM as a single dose, rising to 1 g for persons above 150 kg with documented gonorrhea. In parenteral PID regimen 1 it is 1 g intravenously every 24 hours. Other cephalosporins occupy specific niches rather than being interchangeable — cefoxitin and cefotetan in the parenteral pelvic inflammatory disease regimens, cefixime when ceftriaxone is unavailable, and ceftriaxone again as a penicillin-allergy option in primary and secondary syphilis. Those alternative regimens and their doses belong to the class page; what belongs here is that ceftriaxone is the backbone and that its dose is weight-dependent. Note what is no longer part of the gonorrhea regimen: routine azithromycin. Doxycycline is added only when chlamydia has not been excluded. Cephalosporin generations, spectrum and cross-reactivity belong to the class page.
Azithromycin has three different statuses on one page, and the contrast is the teaching. Preferred: a macrolide is what a pregnant patient with chlamydia receives, which is the exact reversal of the non-pregnant order — and the reason is that tetracyclines are avoided in pregnancy, so the class changes rather than the dose. The pregnancy regimen itself belongs to this class page. Alternative: outside pregnancy it is an alternative first-line for chlamydia, behind doxycycline, and azithromycin is half of the cephalosporin-allergy gonorrhea regimen, paired with gentamicin. Forbidden: for syphilis, "azithromycin should not be used as treatment for syphilis" because of macrolide resistance — so a penicillin-allergic non-pregnant patient gets doxycycline, tetracycline or ceftriaxone, never a macrolide. Holding all three positions at once is what prevents the two commonest errors, which are reaching for azithromycin as the universal single-dose answer and reaching for it when penicillin cannot be used. The disorder-side value of a single observed dose in pregnancy is adherence: it is given and watched rather than dispensed and hoped for, which matters in a population being treated to protect a fetus. Macrolide pharmacokinetics, QT effects and the interaction profile belong to the class page.
Metronidazole is on this page for two separate reasons, and its pelvic inflammatory disease role — the one the first-line chip refers to — is the one students omit. It is in every PID regimen CDC recommends for outpatient care — 500 mg orally twice daily for 14 days — and in parenteral regimen 1 at 500 mg orally or intravenously every 12 hours. The disorder-side reason is microbiological: PID is polymicrobial, and bacterial vaginosis organisms and anaerobes are "also common" in its microbiology alongside gonorrhea, chlamydia and Mycoplasma genitalium. A regimen of ceftriaxone plus doxycycline alone leaves the anaerobic half untreated. Trichomoniasis is treated with this same class, and the metronidazole class page owns it — the regimen, the way it differs by sex, and the pregnancy guidance. This page does not carry those details. The disulfiram-like alcohol reaction, peripheral neuropathy and metallic taste belong to the class page; the fetched STI guideline pages carry no alcohol counselling, so it is not attributed to them here.
Genital herpes sits at the edge of this page rather than inside it. It belongs to the same clinic visit and the same conversation, and a patient with one sexually transmitted infection is screened for the others — but the antiviral class page owns what these drugs do, when a course is episodic rather than suppressive, and what suppression achieves that symptom control cannot. Follow the link; this page carries none of it.
Human papillomavirus vaccination is primary prevention for a cancer, and it belongs in the same conversation as screening — which is why it appears on a page about sexually transmitted infection at all. The vaccines class page owns the schedule, and the schedule is where the errors happen: the number of doses depends on age at the first dose and on immune status, not on current age. What belongs here is remembering to raise it.
Beyond medications
- Screening is the intervention. Grade B for sexually active women 24 or younger and those 25 or older at increased risk, for chlamydia and gonorrhea separately, explicitly including pregnant persons; Grade I for men. No fixed interval — rescreen "patients whose sexual history reveals new or persistent risk factors since the last negative test result." In pregnancy, syphilis screening happens three times: first prenatal visit, about 28 weeks, and at delivery.
- Abstinence instructions have to be given in full, because every clause does work. Patients should abstain until therapy is complete, until symptoms have resolved, and until sex partners have been treated — three conditions, all of which must be met. For gonorrhea the guideline adds a count: abstain "from sexual activity for 7 days after treatment and until all sex partners are treated." The third is the one patients drop, and a patient who counts only the days of her own course and returns to an untreated partner is reinfected. That is exactly what the 3-month retest exists to catch.
- Partner management runs on a 60-day look-back. For gonorrhea, "persons having sexual contact with the infected patient <60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive treatment." For PID, partners from the "60 days preceding symptom onset should be evaluated, tested, and presumptively treated for chlamydia and gonorrhea."
- Expedited partner therapy exists as an option when linkage to care is delayed or unlikely — the guideline states: "If linkage is delayed or unlikely, EPT is an alternative approach to treating sex partners who have chlamydial or gonococcal infection." Whether it may be used is a local-policy question rather than a clinical preference, so check what your jurisdiction and your institution permit before offering it.
- The IUD stays in. "If an IUD user receives a diagnosis of PID, the IUD does not need to be removed." Removal is considered only "if no clinical improvement occurs within 48–72 hours of initiating treatment." Separately, IUD insertion raises PID risk only for the first 3 weeks, not for the duration of use.
- The 72-hour rule is the safety net that makes a low diagnostic threshold safe. Patients "should demonstrate clinical improvement… <3 days after therapy initiation. If no clinical improvement has occurred <72 hours after outpatient IM or oral therapy, then hospitalization, assessment of the antimicrobial regimen, and additional diagnostics" are recommended. Tubo-ovarian abscess needs surgical drainage if it is 8 cm or larger, ruptures, or sepsis develops.
- Doxycycline post-exposure prophylaxis, with its population limit stated every time. 200 mg of doxycycline as soon as possible within 72 hours after oral, vaginal or anal sex, maximum 200 mg every 24 hours; it reduces chlamydia by more than 70%, syphilis by more than 70%, and gonorrhea by approximately 50%. Testing at exposure sites at baseline and every 3 to 6 months. "No recommendation can be given at this time on the use of doxy PEP for cisgender women, cisgender heterosexual men, transgender men, and other queer and nonbinary persons."
- Prevention is the sourced strategy, stated as such: "the most effective way to prevent pelvic inflammatory disease is by reducing the transmission of STIs." The nurse's named role is that "a major focus of care involves patient education and the prevention of pelvic inflammatory disease and STIs," with counselling on "safe sex, the correct use of condoms, and the importance of limiting the number of sexual partners." Reducing the burden requires "an integrated, interprofessional approach with a strong emphasis on public health initiatives."
Nursing considerations
The RN-specific layer — each action paired with the reason it matters.
How a real nurse thinks
The clinical-judgment loop, worked for a typical presentation — reasoning, not reference.
- 1 Recognize cues
Three clusters. The serologic cluster: a reactive nontreponemal test confirmed by a treponemal test, in a patient whose first-trimester screen was nonreactive — so this is very likely an infection acquired during the pregnancy, which is exactly why screening repeats at 28 weeks and at delivery. The staging cluster, which is defined by an absence: no chancre recalled, no rash, no prior positive test, so the duration of infection cannot be established. The allergy cluster: a reported childhood penicillin rash. And then, four hours after treatment, a fourth cluster appears: fever 38.6 °C, chills, myalgia and maternal tachycardia at 112 in a pregnant patient who has just received penicillin.
- 2 Analyze cues
Stage her first, because the stage decides how many injections she needs. She is asymptomatic with syphilis detected serologically, so she is latent. Early latent requires acquisition "within the preceding year," which cannot be documented here — the negative first-trimester screen makes recent acquisition likely, but "likely" is not documentation, and the guideline's category for this is latent of unknown duration, which is treated as late latent. That means 7.2 million units total, as three doses of 2.4 million units one week apart, not the single 2.4 million unit injection that early latent would earn. The allergy is the second analysis. In pregnancy there is no alternative to penicillin — it "is the only therapy with documented efficacy for syphilis during pregnancy" — so the answer is not doxycycline, which is also a pregnancy-avoided drug, and it is certainly not azithromycin, which is rejected for syphilis outright because of resistance. The answer is desensitization. The fourth cluster is then straightforward to name and easy to mishandle: fever, chills, myalgia and tachycardia within 24 hours of the first dose is a Jarisch-Herxheimer reaction, which occurs in as many as 40% of treated maternal cases. It is the dying organisms, not an allergy.
- 3 Prioritize
Before treatment, the priority is getting the first injection in today rather than at the next visit — and the reason is not the 30-day rule, which a course finishing around 30 weeks clears comfortably. It is the interval discipline of a three-dose weekly course: doses are preferably 7 to 9 days apart, an interval of 10 to 14 days is the outer tolerance, and beyond that the sequence restarts from the beginning. Every week of delay in starting is a week in which a missed appointment costs her the whole course rather than one dose. Alongside that, arrange desensitization rather than accepting a substitute. After the first injection, the priority changes entirely: continuous fetal heart monitoring for up to 24 hours, because the sourced risks of a Jarisch-Herxheimer reaction in pregnancy are fetal distress and preterm labor. What is explicitly not a priority: stopping the penicillin. The reaction is expected, usually resolves within 24 hours, and there is no alternative drug to switch to.
- 4 Generate solutions
Anticipate penicillin desensitization followed by benzathine penicillin G 2.4 million units intramuscularly, repeated weekly for three doses, with the missed-dose tolerance known in advance: 7 to 9 days between doses is preferred and 10 to 14 days is the outer limit, beyond which the sequence restarts from the beginning. Anticipate the Jarisch-Herxheimer reaction and prepare for it before it happens, with the fetal monitor available and the patient warned. Anticipate continuous fetal monitoring for up to 24 hours if it develops, watching for contractions and for fetal heart-rate change. Anticipate follow-up nontreponemal titers at 6, 12 and 24 months, remembering that these are the only tests that monitor treatment and that a fourfold change is what counts as significant. Anticipate neonatal involvement planning, because 70% of infants with congenital syphilis are asymptomatic at birth and the pediatric team works from her serology rather than the baby's appearance. And anticipate partner notification and treatment.
- 5 Take action
Escalate the allergy for desensitization and say why in the handoff: there is no substitute in pregnancy, and she should have priority. Warn her before the first injection that fever, chills and aching within the next day are expected, are not an allergy, and are not a reason to skip the second and third doses — a patient who experiences an unexplained fever at home very often does not come back for dose two. Give the injection, then apply continuous fetal monitoring and keep it running for up to 24 hours once the reaction appears, watching for contractions and fetal heart-rate change. Give antipyretics and supportive care for the reaction itself. Write the second and third dose dates in the chart and give them to her in writing, with the 7-to-9-day preferred interval explained. Notify partners from the appropriate look-back and arrange their evaluation and presumptive treatment. Document the completion date against the 30-day-before-delivery requirement so that nobody downstream has to reconstruct it.
- 6 Evaluate
Evaluate on three different clocks. Within 24 hours: the Jarisch-Herxheimer reaction should resolve, and the fetal tracing should stay reassuring with no established preterm contractions. Within 3 weeks: all three injections given, at 7-to-9-day intervals where possible, with completion more than 30 days before her expected delivery — the criterion that defines adequate maternal treatment. Over 2 years: nontreponemal titers at 6, 12 and 24 months, with a fourfold decline as the marker of response. Know what failure looks like: "at least a fourfold increase in nontreponemal test titer persisting for >2 weeks," or failure of titers to decrease fourfold within 12 months — either of which means treatment failure or reinfection, and reinfection is why partner treatment matters as much as hers does. At delivery, she is screened again, and the neonatal team assesses the infant on the basis of her serology and treatment adequacy, not on how the baby looks.
Scenario — you’re the nurse
Work each question before revealing the answer. Rationales explain the wrong options too.
A 31-year-old at 28 weeks of gestation, gravida 2 para 1. Her first-trimester syphilis screen was nonreactive. Routine repeat screening at this visit returns a reactive RPR, confirmed by treponemal testing. She recalls no genital ulcer and has no prior positive test.
Q1 Multiple choice A 23-year-old who is 12 weeks pregnant tests positive for chlamydia. The provider orders doxycycline. The nurse should: - A. Give the dose, since doxycycline is first-line for chlamydia
- B. Hold the dose and clarify the order, because tetracyclines are avoided in pregnancy and the pregnancy regimen is a macrolide instead
- C. Give the dose and add a macrolide for coverage
- D. Hold the dose and clarify, because chlamydia is not treated during pregnancy
Reveal answer & rationale
Q2 Select all that apply A 22-year-old with an IUD placed five months ago is diagnosed with pelvic inflammatory disease. Her temperature is 38.4 °C, she is tolerating oral intake, and a pregnancy test is negative. Which actions are correct? Select all that apply. - A. Remove the IUD before starting antibiotics
- B. Treat with ceftriaxone 500 mg IM once, plus doxycycline 100 mg orally twice daily for 14 days, with metronidazole 500 mg orally twice daily for 14 days
- C. Refer partners from the preceding 60 days for evaluation, testing and presumptive treatment
- D. Reassess for clinical improvement within 72 hours
- E. Admit her, since her temperature is above the supportive criterion of 38.3 °C
Reveal answer & rationale
Q3 Put in order A pregnant patient receives her first benzathine penicillin G injection for latent syphilis. Four hours later she has a fever of 38.6 °C, chills, myalgia and a heart rate of 112. Put the nurse's actions in priority order: - A. Give antipyretics and supportive care
- B. Apply continuous fetal heart monitoring and maintain it for up to 24 hours
- C. Recognize this as a Jarisch-Herxheimer reaction rather than an allergic reaction
- D. Confirm the dates of the second and third injections with the patient
Reveal answer & rationale
Q4 Multiple choice A non-pregnant patient with a documented severe penicillin allergy has primary syphilis. Which alternative is acceptable? - A. Azithromycin, since it is a reliable single-dose alternative
- B. Doxycycline, tetracycline or ceftriaxone, each given as a multi-day course
- C. Metronidazole, which covers the organism in penicillin-allergic patients
- D. No treatment, since penicillin allergy makes syphilis untreatable
Reveal answer & rationale
Q5 Multiple choice Which statement by a patient treated for chlamydia indicates that teaching was effective? - A. "I can have sex again as soon as I finish the pills."
- B. "I will wait until I have finished the course, until my symptoms are gone, and until my partner has been treated — and I will come back for a repeat test in three months."
- C. "My partner only needs treating if he has symptoms."
- D. "Since I finished the antibiotics, my partner does not need to be tested."
Reveal answer & rationale
Common questions
What causes stis & pid?
What are the early signs of stis & pid?
Which findings should a nurse report immediately in stis & pid?
Why is doxycycline first-line for chlamydia but not used in pregnancy?
Should an IUD be removed when a patient develops pelvic inflammatory disease?
Why are nontreponemal titers the test that follows a treated patient?
Sources
- Chlamydia and Gonorrhea: Screening — Final Recommendation Statement (14 September 2021) — US Preventive Services Task Force
- Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial STI Prevention, 2024 — CDC — MMWR Recommendations and Reports 2024;73(RR-2):1-8
- STI Treatment Guidelines, 2021 — Primary and Secondary Syphilis — Centers for Disease Control and Prevention
- STI Treatment Guidelines, 2021 — Latent Syphilis — Centers for Disease Control and Prevention
- STI Treatment Guidelines, 2021 — Pelvic Inflammatory Disease — Centers for Disease Control and Prevention
- Congenital and Maternal Syphilis — StatPearls — StatPearls (NCBI Bookshelf)
- Pelvic Inflammatory Disease — StatPearls — StatPearls (NCBI Bookshelf)
- Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 70(4)) — CDC (PMC, public domain)
Reviewed by Hae Suk Lee, RN
Educational summary for nursing students. Scenarios are fictional teaching cases. Always verify against current guidelines and your institution's protocols before acting in practice. Not medical advice.