First line:

Ceftriaxone IM 1g as a single dose

and

Metronidazole oral 400mg 12 hourly for 14 days 

and

Doxycycline oral 100mg 12 hourly for 14 days

N.B. In pregnant patients, doxycycline is contraindicated.

Second line:

Ofloxacin should be avoided in patients who are at high risk of gonococcal PID because of increasing quinolone resistance in the UK.

Ofloxacin oral 400mg 12 hourly for 14 days

and

Metronidazole oral 400mg 12 hourly for 14 days

• Signs of PID include lower abdominal tenderness which is usually bilateral, fever >38°C, and adnexal or cervical motion tenderness. Due to a risk of long term sequelae in untreated disease, a low threshold for empirical treatment of suspected PID is recommended. 
• Do not remove an intra-uterine device (IUD) if present at time of diagnosis, but review after 48h and consider removal if no improvement. If the IUD is removed, consider the risk of pregnancy and commence alternative form of contraception.
• Take a swab for PCR for gonorrhoea & chlamydia (“NAATs”). A positive result supports PID diagnosis, but a negative result does not exclude it. All patients should be offered a pregnancy test.
• Patients should abstain from unprotected sexual intercourse until they and their partner(s) have completed treatment and follow-up.
• Refer both the case and their sexual contacts to the Sexual Health service.
• A full sexually-transmitted infection screen is advised, including HIV testing. All sexual partners should be offered, and encouraged to take up, full STI screening, including HIV testing and (if indicated) hepatitis B screening +/- vaccination. For advice or assistance with partner notification, please phone the Sexual Health Advisers on 01294 323228.