Pelvic inflammatory disease
Ascending: chlamydia, gonorrhoea, M. genitalium, anaerobes
Overview
Infection of the upper female genital tract (endometritis, salpingitis, tubo-ovarian abscess, peritonitis). Treated empirically and early to protect fertility; a low diagnostic threshold is recommended.
Recognise
- Bilateral lower abdominal/pelvic pain, deep dyspareunia
- Abnormal discharge/bleeding (post-coital, intermenstrual)
- Cervical motion tenderness, adnexal tenderness, fever
- Fitz-Hugh–Curtis (perihepatitis): RUQ pain
Red flags
- Tubo-ovarian abscess, sepsis, pregnancy/ectopic, unable to tolerate oral → admit
Differentials & how to tell them apart
Investigations
Clinical diagnosis — do not delay treatment for tests. NAAT (chlamydia/gonorrhoea/M. genitalium), pregnancy test (exclude ectopic), bloods, consider pelvic USS/laparoscopy if severe.
Management
Ceftriaxone 1 g IM single dose + doxycycline 100 mg BD ×14d + metronidazole 400 mg BD ×14d
- 1Empirical outpatient: ceftriaxone 1 g IM single dose + doxycycline 100 mg BD ×14d + metronidazole 400 mg BD ×14d. Start before results.Gate: Admit for IV therapy if pregnant, severe/septic, tubo-ovarian abscess, or unable to tolerate oral
- 2IUD in situ with mild–moderate PID: can stay if improving within 48–72h; remove if not improving.
- 3Analgesia; avoid intercourse until treated.
Key points
Low threshold to treat — delay risks tubal infertility, ectopic and chronic pain. Always do a pregnancy test (ectopic mimics PID).
Monitor & prognosis
Review at 72h for response; ensure partner treatment; fertility counselling.
Early treatment preserves fertility; recurrence/severe disease worsens outcomes.
Source: NICE CKS PID (2025); BASHH