Acute severe pelvic inflammatory disease (PID).

• All patients should be discussed with Gynaecology and referred to GUM.
• Pregnancy test
• Vaginal/cervical examination and documentation
• Sexual health screen including microscopy and Chlamydia/gonococcal NAAT and culture and venous blood for HIV/Syphilis. Testing for Mycoplasma genitalium is recommended for women presenting with possible PID and the male partners of confirmed Mycoplasma genitalium infection. Abnormal cervical discharge is associated with PID; however, absence of cervical white cells on microscopy makes PID extremely unlikely (negative predictive value 95%, compared to positive predictive value just 17%). Further information below under 'Notes / Comments'.

Ceftriaxone* IV 2g daily (continue until 24 hours after clinical improvement)

and

Doxycycline** oral 100mg 12 hourly if tolerated 

and

Metronidazole oral 400mg 12 hourly

Total course duration (of oral antibiotics): 14 days.

If true penicillin / beta-lactam allergy:

Contact microbiology / infectious diseases unit or Sandyford for advice (see Appendix 6 for contact details).

*Ceftriaxone:

• Protected antimicrobial - complete order form.
• Must not be mixed with calcium-containing solutions, and must not be given to any patient simultaneously with calcium-containing solutions – even via different infusion lines.

^**Doxycycline: interactions - for details of important interactions see here and BNF Appendix 1.

If initial test for Mycobacterium genitalium is positive, contact Sandyford for advice (Appendix 6 for contact details).