Synopsis
Diagnose pelvic inflammatory disease clinically, exclude pregnancy emergencies, start broad treatment without delay and manage abscess, partners and reproductive-health follow-up.
- Pelvic inflammatory disease is ascending infection and inflammation of the endometrium, fallopian tubes, ovaries and adjacent peritoneum.
- Maintain a low threshold for empirical treatment with pelvic pain and cervical-motion, uterine or adnexal tenderness after important alternatives are assessed.
- A negative cervical chlamydia or gonorrhoea test does not exclude upper-genital-tract infection.
Key red flags
Positive pregnancy test with pain, bleeding, syncope or shoulder-tip pain requires emergency ectopic assessment.
High fever, vomiting, marked focal adnexal tenderness, pelvic mass or peritonism suggests severe disease or tubo-ovarian abscess.
Investigation priorities
Identify ectopic pregnancy risk and alter antimicrobial and admission decisions.
Management branches
Pelvic inflammatory disease is likely, the patient is stable and no admission criterion or surgical emergency is present.
- Perform pregnancy testing, pelvic assessment and STI sampling, but do not await results when the clinical treatment threshold is met.
- Give ceftriaxone 1 g intramuscularly once plus doxycycline 100 mg twice daily and metronidazole 400 mg twice daily for 14 days.
Key medicines
Ceftriaxone, doxycycline and metronidazoleGive ceftriaxone 1 g intramuscularly once, doxycycline 100 mg orally twice daily for 14 days and metronidazole 400 mg orally twice daily for 14 days.
Ceftriaxone plus doxycycline inpatient regimenGive ceftriaxone 2 g intravenously once daily plus doxycycline 100 mg orally or intravenously twice daily until improvement, then complete 14 days with doxycycline and metronidazole.