PID regimens, TOA, and partner treatment

PID is a clinical diagnosis. Minimum criteria: cervical motion, uterine, or adnexal tenderness with no competing diagnosis — treat empirically.^[1]

Outpatient: ceftriaxone 500 mg IM once (1 g if weight >150 kg) + doxycycline 100 mg BD for 14 days + metronidazole 500 mg BD for 14 days.^[1][2]

Admit and 72-hour failure: pregnancy, TOA, severe illness/peritonitis/sepsis, unable to tolerate orals, uncertain surgical diagnosis, failed OP therapy — admit, IV antibiotics, image for TOA, gynae drainage if indicated; always arrange partner treatment and STI follow-up. Persistent symptoms need M. genitalium testing and resistance-aware management — doxycycline is relatively poor for M. genitalium, and resistance-guided therapy outperforms empirical treatment.^[1][4]