A 43-year-old man is seen in his physician’s office for severe pain in the perineum. Examination reveals exquisite tenderness in the area to the right side of the anal verge due to a perianal abscess. Rectal examination is refused. What should be the next step in management?

**Core Concept**
The management of a perianal abscess involves incision and drainage to relieve the collection of pus and prevent further complications. The decision to perform an incision and drainage should be made after considering the patient's symptoms, clinical examination, and the potential risks associated with the procedure.

**Why the Correct Answer is Right**
The correct answer involves performing an incision and drainage of the abscess. This is done to relieve the collection of pus and reduce the pain and discomfort associated with the abscess. The incision is typically made under local anesthesia, and the abscess is drained to allow the body to heal the area. The procedure should be performed in an outpatient setting, and the patient should be advised to follow a course of antibiotics to prevent further infection.

**Why Each Wrong Option is Incorrect**
**Option A:** Antibiotics alone would not be sufficient to manage a perianal abscess, as they do not address the physical collection of pus.
**Option B:** A rectal examination is not necessary in this scenario, and refusing to undergo one does not preclude the need for an incision and drainage.
**Option C:** MRI or CT scans may be useful in some cases to rule out other conditions, but they are not the next step in management of a perianal abscess.

**Clinical Pearl / High-Yield Fact**
It's essential to note that the timing of incision and drainage is critical, and delaying the procedure can lead to further complications, such as abscess rupture, fistula formation, or sepsis.

**Correct Answer: C.**

✓ Correct Answer: A. Drainage of the abscess in the office under local anesthesia.