AKT · Obstetrics & gynaecology/Menopause & vulvallow yield

Pelvic inflammatory disease (gynae)

Ascending STI/anaerobic infection (see Sexual Health page)

Overview

Covered in depth on the Sexual Health page. Listed here as a content-map gynaecology item: upper genital tract infection treated empirically with ceftriaxone + doxycycline + metronidazole; always exclude ectopic pregnancy.

Recognise

Bilateral pelvic pain, deep dyspareunia, abnormal bleeding/discharge
Cervical motion tenderness, adnexal tenderness, fever

Red flags

Exclude ectopic pregnancy (pregnancy test); tubo-ovarian abscess/sepsis → admit

Differentials & how to tell them apart

Ectopic pregnancypositive pregnancy test — must exclude

AppendicitisRIF pain, migratory

Ovarian torsion/cystsudden unilateral, USS

Investigations

NAAT, pregnancy test (exclude ectopic), clinical diagnosis — do not delay treatment. See Sexual Health page.

Management

Ceftriaxone 1 g IM + doxycycline 100 mg BD 14d + metronidazole 400 mg BD 14d

1Empirical antibiotics (ceftriaxone + doxycycline + metronidazole); low threshold to treat. Full detail on the Sexual Health page.

Ceftriaxone + doxycycline + metronidazole — empirical regimen

Key points

Cross-referenced — see the Sexual Health page (sexual_health.html) for the full card incl. partner notification.

Monitor & prognosis

Response at 72h; fertility counselling.

Early treatment preserves fertility.

Source: NICE CKS PID (see Sexual Health page)