A 23-year-old nulliparous woman presents with intermittent purulent vaginal discharge and bleeding a

A 23-year-old nulliparous woman presents with intermittent purulent vaginal discharge and bleeding after intercourse for the past few months. She is sexually active with multiple male partners and uses condoms inconsistently. She also reports smoking 10 cigarettes daily. Her temperature is 101 °F (38.3 °C). The abdominal examination is notable for significant tenderness and purulent discharge, and blood is seen at the cervical os during the pelvic exam. An in-office urine pregnancy test is negative. Given the likely diagnosis, which of the following patient factors has most increased her risk for this condition? A. Tobacco use B. Nulliparity C. Age younger than 25 D. Unprotected intercourse with multiple partners

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