Executive summary
- Do not delay treatment if PID is suspected — diagnosis is clinical.
- Exclude pregnancy (pregnancy test) and consider ectopic if pain/bleeding.
- CKS first-line: ceftriaxone 1 g IM stat + doxycycline 100 mg BD + metronidazole 400 mg BD for 14 days.
Work-up (do not delay antibiotics)
- STI NAAT (chlamydia/gonorrhoea), consider HIV/syphilis per risk; urinalysis; FBC/CRP if systemic symptoms.
- Review at ~72 hours (sooner if worse). If no improvement, reassess and escalate.
Admission / urgent referral criteria
- Pregnancy, suspected ectopic, severe illness/sepsis, peritonism, suspected abscess, unable to tolerate oral meds, immunosuppression, or diagnostic uncertainty.
- Safety-net: worsening pain, syncope, heavy bleeding, fever/rigors, persistent vomiting.
Partner management and follow-up
- Partner notification/treatment via sexual health services; advise no sex until treatment complete and partners treated.
- Discuss fertility/ectopic risk; ensure follow-up if symptoms persist or recur.
Frequently asked questions
Do I need a scan first?
No if clinical suspicion is high; treat promptly. Imaging helps if diagnosis is uncertain or abscess/ectopic suspected.
What if swabs are negative?
PID is not excluded; continue treatment if clinical features fit and reassess if not improving.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.