{"id":11393,"date":"2026-11-09T00:10:00","date_gmt":"2026-11-09T08:10:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=11393"},"modified":"2026-10-22T12:29:03","modified_gmt":"2026-10-22T20:29:03","slug":"usmle-step-1-question-of-the-day-pelvic-pain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Pelvic pain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_89 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pelvic-pain\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em style=\"font-weight: bold;\">Today\u2019s USMLE\u00ae Step 1 question of the day features a 22-year-old woman with pelvic pain and bleeding. What<\/em><strong><em>&#8216;s the diagnonsis? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>22-year-old woman<\/strong> comes to the clinic with a <strong>history of pelvic pain and vaginal bleeding immediately after sexual intercourse for the last 3 weeks<\/strong>. The patient has taken oral contraceptive pills for the past three months. Her menstrual cycles are regular and occur every 28 days and last for five days. Past medical history is significant for a gonococcal infection four years ago. Temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 90\/min, respirations are 20\/min, and blood pressure is 120\/75 mmHg. On speculum examination, the cervix appears friable with mucopurulent discharge from the cervical os. Cervical motion tenderness is present. Vaginal swabs are sent to the lab and are pending. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>This patient should be empirically treated for <em>which of the following organisms?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Neisseria gonorrhoeae<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Chlamydia trachomatis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Neisseria gonorrhoeae and Chlamydia trachomatis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Candida albicans<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Trichomonas vaginalis<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Neisseria gonorrhoeae and Chlamydia trachomatis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Neisseria gonorrhoeae<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Empiric treatment should cover both Neisseria gonorrhoeae and Chlamydia trachomatis because both are common causes of cervicitis and PID, and coinfection may occur. Treatment for one organism (e.g. with ceftriaxone alone) would be inappropriate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Chlamydia trachomatis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Empiric treatment should cover both Neisseria gonorrhoeae and Chlamydia trachomatis because both are common causes of cervicitis and PID, and coinfection may occur. Treatment for one organism (e.g. with doxycycline alone) would be inappropriate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Candida albicans<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Symptoms of vaginal candidiasis include pruritus and thick, curdy white vaginal discharge, as opposed to mucopurulent cervical discharge. In addition, this patient\u2019s cervical friability and cervical motion tenderness are characteristic of a diagnosis of acute cervicitis and pelvic inflammatory disease (PID), which are not caused by Candida albicans.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Trichomonas vaginalis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Patients with trichomoniasis typically present with malodorous vaginal discharge and often have the additional findings of dysuria and an erythematous, \u201cstrawberry\u201d cervix (i.e. punctate hemorrhages). In contrast, this patient\u2019s cervical friability and cervical motion tenderness are more suggestive of gonococcal or chlamydial cervicitis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"975\" height=\"514\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/11\/image_4c9397.png\" alt=\"Osmosis.org style illustration of pelvic inflammatory disease (PID), showing ascending infection of the female reproductive tract causing endometritis in the uterus, salpingitis in the fallopian tubes, and oophoritis in the ovaries, with chlamydia and gonorrhea identified as major causes.\n\" class=\"wp-image-11396\" style=\"aspect-ratio:1.8969384990517475;width:510px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/11\/image_4c9397.png 975w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/11\/image_4c9397.png?resize=300,158 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/11\/image_4c9397.png?resize=768,405 768w\" sizes=\"auto, (max-width: 975px) 100vw, 975px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient has pelvic pain, cervical motion tenderness, a friable cervix, mucopurulent discharge, and vaginal bleeding after sexual intercourse. This presentation is consistent with <strong>acute cervicitis<\/strong> and is concerning for <strong>pelvic inflammatory disease (PID)<\/strong>.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Neisseria gonorrhoeae<\/em><\/strong> and <strong><em>Chlamydia trachomatis<\/em><\/strong> are the leading causes of acute cervicitis and PID in patients with female genitalia who are sexually active. Symptoms of cervicitis include vaginal irritation, dysuria, dyspareunia, <strong>mucopurulent cervical discharge<\/strong> and a <strong>friable cervix<\/strong> on exam. If the infection spreads to the upper genital tract, like in PID, additional symptoms may include lower abdominal or pelvic pain, abnormal vaginal bleeding, fever, and <strong>cervical motion tenderness<\/strong> on exam. Diagnostic evaluation of suspected cervicitis includes a pelvic exam (including a speculum evaluation of the cervix) and <strong>nucleic acid amplification tests<\/strong> (NAAT) for both <em>Chlamydia trachomatis<\/em> and <em>Neisseria gonorrhoeae<\/em>.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The presence of symptoms suggestive of acute cervicitis or PID requires prompt, <strong>empiric antibiotic treatment<\/strong>. Because <em>Neisseria gonorrhoeae<\/em> and <em>Chlamydia trachomatis<\/em> are the most common STI-associated causes of cervicitis and PID, empiric therapy should cover both organisms while testing is pending, particularly in high-risk patients. In the outpatient setting, empiric treatment for acute cervicitis typically includes intramuscular <strong>ceftriaxone<\/strong> and oral <strong>doxycycline<\/strong>. Empiric treatment for PID may also include <strong>metronidazole<\/strong> for additional anaerobic coverage.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Neisseria gonorrhoeae<\/em> and <em>Chlamydia trachomatis<\/em> are the most common STI-associated causes of acute cervicitis and pelvic inflammatory disease (PID). Because treatment should not be delayed while lab results are pending, empiric therapy should cover both organisms; typically with intramuscular ceftriaxone and oral doxycycline.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:<\/strong> <a href=\"https:\/\/www.osmosis.org\/learn\/Pelvic_inflammatory_disease\">Pelvic inflammatory disease<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Workowski KA, Bolan GA; Centers for Disease Control and Prevention. <strong>Sexually transmitted diseases treatment guidelines, 2015.<\/strong> MMWR Recomm Rep. 2015 Jun 5;64(RR-03):1-137. Erratum in: MMWR Recomm Rep. 2015 Aug 28;64(33):924. PMID: 26042815; PMCID: PMC5885289.<\/li>\n\n\n\n<li>Marrazzo JM, Handsfield HH, Whittington WL. <strong>Predicting chlamydial and gonococcal cervical infection: implications for management of cervicitis. <\/strong>Obstet Gynecol. 2002 Sep;100(3):579-84. doi: 10.1016\/s0029-7844(02)02140-3. PMID: 12220782.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><strong>Want more practice questions? Get your\u00a0<a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0to discover why millions of clinicians and caregivers love learning by Osmosis<\/strong>!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 22-year-old woman presents with pelvic pain, postcoital bleeding, and abnormal cervical findings. Can you identify the most appropriate empiric treatment approach while laboratory results are pending?<\/p>\n","protected":false},"author":208,"featured_media":11397,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_hide_featured_image":false,"_jetpack_featured_image_duplicate_dismissed":0,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[2967,3493,489,3494,1807,614,84,3495,462,324,1802,321,1024,664,3496],"class_list":["post-11393","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-board-exam-prep","tag-cervicitis","tag-clinical-reasoning","tag-empiric-treatment","tag-gynecology","tag-infectious-diseases","tag-medical-education","tag-microbiology","tag-osmosis","tag-pelvic-inflammatory-disease","tag-pelvic-pain","tag-reproductive-health","tag-sexually-transmitted-infections","tag-usmle-step-1","tag-vaginal-bleeding"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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