363) A 25 year old woman presents to your office with complaints of inter-menstrual vaginal bleeding for the past one month. She is sexually active. She never used barrier methods for contraception but she has been on cyclical combination oral contraceptive pills ( Ethinyl estradiol + Levonorgestrol) for the past 3 months. She denies any fever or vaginal discharge or dysuria or pain. Her menstrual periods occur as scheduled every month during the pill free period however, she also has been experiencing inter-menstrual bleeding only for the past one month and sometimes, more after sexual activity. She never had irregular bleeding in the past and her scheduled periods have always been regular and on time. She denies smoking , alcohol or drug use. Upon physical examination, she is afebrile. There is no obvious vaginal discharge. When gentle endocervical swabbing is attempted, bleeding from endocervix is noted. On bimanual examination, she has no adnexal tenderness. A urine pregnancy test is negative. Which of the following is the most appropriate first management option?
A) Reassure that this is OC Pill related bleeding and will abate.
B) Test for N. gonorrhoeae and C. trachomatis
C) Increase the dose of Ethinyl Estradiol
D) Empiric antibiotic therapy for Gonorrhea and Chlamydia
E) Discontinue OC pills