Acute severe pelvic inflammatory disease (PID).

Where a history is suggestive of PID routine investigations should consist of:

1. Pregnancy test
2. Vaginal/cervical examination and documentation
3. 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'.
4. CRP (if normal excludes a significant inflammatory process; high levels correlate with disease severity; best indicator of treatment response if raised initially). Send on CHI labels with patient’s permission.
5. Full blood count (FBC). Send on CHI labels with patient’s permission.
6. If clinically unwell: perform and document Temp, Pulse and BP.

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

and

Doxycycline** oral 100mg 12 hourly if tolerated or IV 100mg 12 hourly (unlicensed preparation) 

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 antibiotic - complete 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 BNF or Medicines Update article on cation interactions (January 2014) here (or search in the Medicines Update section of the App).

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