A pregnant woman at 8 weeks gestation presents with heavy mucopurulent discharge and a friable cervix. The most likely diagnosis is acute cervicitis, and the next step is azithromycin.

• A. Acute cervicitis; azithromycin
• B. Pelvic inflammatory disease; doxycycline
• C. Acute cervicitis; doxycycline
• D. Acute cervicitis; metronidazole

Answer: (A)

In pregnancy, a friable cervix with heavy mucopurulent discharge points to cervicitis, most commonly due to sexually transmitted pathogens like Chlamydia trachomatis or Neisseria gonorrhoeae. The immediate goal is to treat the infection with an agent that is safe for the fetus and effective against these organisms.

Azithromycin is preferred in pregnancy because it safely treats Chlamydia and often covers gonorrhea when used in combination with other agents in practice. Doxycycline, though effective for Chlamydia, is contraindicated in pregnancy due to potential fetal harm. Metronidazole would not adequately treat cervicitis driven by these pathogens. Pelvic inflammatory disease is a possible complication if the infection ascends, but the presentation here is cervicitis, not established PID, and the first-step choice focuses on treating cervicitis safely in pregnancy.

Therefore, diagnosing acute cervicitis and treating with azithromycin aligns with safety in pregnancy and effectiveness against common causative organisms.