Pelvic Inflammatory Disease (PID) Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Meets criteria/needs admission
   Meets CDC minimum criteria? Needs admission? (Ascending infection of the female upper genital tract (often STI-related), a clinical diagnosis. CDC minimum criteria (empiric treatment if ≥1 pelvic exam finding): cervical motion tenderness OR uterine tenderness OR adnexal tenderness — treat a sexually active/high-risk woman with lower abdominal/pelvic pain and no other cause (low threshold, to prevent infertility/ectopic/chronic pain). Must do a pregnancy test to exclude ectopic, and exclude appendicitis.)
   • Severe/pregnant/TOA/cannot exclude surgical emergency/oral failure → Inpatient IV · drain TOA
   • Mild-moderate, can be outpatient → Outpatient triple therapy
   • Does not meet minimum criteria → Does not meet criteria
2. [End] Does not meet criteria
   Does not meet minimum criteria: evaluate other causes of lower abdominal/pelvic pain (ectopic pregnancy — always pregnancy test, ovarian torsion, appendicitis, urinary/bowel pathology, etc.), work up along the relevant pathway (pelvic ultrasound, etc.).
3. [End] Outpatient triple therapy
   Mild-moderate, outpatient: ceftriaxone 500 mg IM single dose (1 g if >150 kg) + doxycycline 100 mg PO bid x14 days + metronidazole 500 mg PO bid x14 days; symptomatic care (analgesia/antiemetic); follow up at 48–72 h, escalate/admit if no improvement; screen and treat partners, test for gonorrhea/chlamydia.
4. [End] Inpatient IV · drain TOA
   Needs admission/IV (severe, pregnant, TOA, cannot exclude surgical emergency, oral failure, cannot tolerate oral): ceftriaxone 1 g IV q24h + doxycycline 100 mg PO/IV q12h + metronidazole 500 mg q12h (or cefotetan/cefoxitin + doxycycline; or clindamycin + gentamicin). A large or non-resolving tubo-ovarian abscess (TOA) → drainage/surgery; supportive care.

Source guidelines & references

• Pelvic inflammatory disease (CDC 2021 STI treatment guidelines) · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways