Ascending infection of upper genital tract; chlamydia, gonorrhoea, anaerobes.
History taking
- • Lower abdominal pain, abnormal discharge, dyspareunia, fever, IMB / PCB
Examination
- • Cervical motion tenderness, adnexal tenderness
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • NAAT for chlamydia / gonorrhoea, HIV, syphilis
- • Pregnancy test, β-hCG
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Ceftriaxone 1 g IM single + doxycycline 100 mg BD × 14 d + metronidazole 400 mg BD × 14 d
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Partner notification & treatment, condom use
- • Risk of infertility, ectopic, chronic pain
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
