NEW dossier authored 2026-05-15 (shard-5-obped-id Phase C wave 5) — pelvic inflammatory disease (PID) including tubo-ovarian abscess (TOA) phenotype; polymicrobial upper genital tract infection in sexually active reproductive-age women. Acute gyn emergency when TOA / sepsis features. Long-term sequelae if untreated: infertility (1 episode 12 %; 2 episodes 25 %; ≥ 3 episodes 50 %); ectopic-pregnancy risk 6-10× baseline; chronic pelvic pain 30-40 %. Backbone: CDC STI Treatment Guidelines 2021 (Workowski PMID 34292926) is the primary US canonical reference; ACOG Practice Bulletin 232 (2021) is the gynecology bulletin; WHO STI Treatment 2021 aligns globally; PEACH trial (Ness AJOG 2002 PMID 12015499) anchors the outpatient-acceptable-for-mild-moderate-PID consensus; CDC 2024 STI Treatment update anticipated (PMID NEEDS_SOURCE_REVIEW). Manifest reused from `prisma/seed/manifests/id.sepsis.core.v1.ts` per shard-5 Phase C wave 5 authoring instruction (nearest-ID precedent); dedicated PID manifest deferred to Phase D. Domain mapped to `obstetrics` — closest DossierDomain enum value (no `gynecology` enum; sibling gyn.ovarian-torsion.v1 uses same mapping). CDC minimum criteria intentionally LOW-threshold to prevent long-term sequelae: (1) sexually active reproductive-age female + (2) pelvic / lower-abdominal pain + (3) ≥ 1 of cervical motion / uterine / adnexal tenderness on bimanual exam + (4) no other identifiable cause. Additional specificity criteria: fever > 38.3 °C, mucopurulent cervical discharge or cervical friability, abundant WBCs on saline microscopy, elevated ESR/CRP, lab-confirmed cervical N. gonorrhoeae / C. trachomatis / M. genitalium. Outpatient regimen (CDC STI 2021): ceftriaxone 500 mg IM × 1 + doxycycline 100 mg PO BID × 14 d + metronidazole 500 mg PO BID × 14 d (metronidazole added 2021 to cover anaerobes vs older 2015 guidance which made it optional). Inpatient regimens (CDC STI 2021): Regimen A — cefotetan 2 g IV q12h OR cefoxitin 2 g IV q6h + doxycycline 100 mg PO/IV q12h; Regimen B — clindamycin 900 mg IV q8h + gentamicin (loading 2 mg/kg → maintenance) for beta-lactam allergy; Regimen C — ampicillin-sulbactam 3 g IV q6h + doxycycline. Pregnancy regimen (ACOG PB 232; CDC STI 2021): admit + ceftriaxone IV + azithromycin (avoid doxycycline + metronidazole first trimester). MFM consult + fetal monitoring per GA. M. genitalium macrolide-resistant pathway (CDC STI 2021): moxifloxacin 400 mg PO daily × 14 d with test-of-cure at 3-6 weeks. TOA management (ACOG PB 232): antibiotics × 7-14 d minimum; image-guided drainage by IR for TOA ≥ 7-8 cm OR failed antibiotic response at 48-72 h; laparoscopy / laparotomy if rupture (emergency). Repeat imaging at 48-72 h to assess size reduction. Severity triggers (10): pid_with_toa_at_diagnosis (severe — admit + IV + drainage decision); toa_rupture_emergent_or (life-threatening — emergent OR + ICU + routes to id.sepsis.core.v1); pid_in_pregnancy (severe — admit + IV ceftriaxone + azithromycin + MFM); outpatient_treatment_failure_at_72h (severe — admit + IV + reimage); iud_in_situ_with_pid_diagnosis (moderate — retain IUD if responding at 48-72 h, remove if not); severe_pid_with_sepsis_features (life-threatening — routes to id.sepsis.core.v1); pid_with_mycoplasma_genitalium_macrolide_resistance (severe — moxifloxacin pathway); hiv_coinfection_with_pid (severe — lower admission threshold); recurrent_pid_with_long_term_sequelae (moderate — fertility counseling + REI referral); expedited_partner_therapy_eligible (mild — CDC EPT regimen where legal reduces re-infection ~ 30 %). Bayesian linkage (documented in _briefs/gyn.pelvic-inflammatory-disease.core.v1.md): pre-test priors per CDC STI 2021 + ACOG PB 232 — PID in reproductive-age women in ED with pelvic pain ~ 5-10 %; TOA in PID admissions ~ 15-20 %; PID in pregnancy is rare (most PID is in non-pregnant patients). LR data: cervical motion tenderness + adnexal tenderness LR+ ≈ 4-5 for PID; TVUS adnexal mass with fluid LR+ very high for TOA; mucopurulent cervical discharge LR+ ≈ 3-4 additional specificity; abundant WBCs on saline microscopy LR+ ≈ 2-3; lab-confirmed GC/CT NAAT LR+ very high for PID etiology. Decision thresholds: T_treat = empiric broad treatment at CDC minimum criteria threshold (intentionally low to prevent long-term sequelae per CDC STI 2021); T_test = alternative dx workup if pain pattern atypical (e.g., ectopic, ovarian torsion, appendicitis). Cross-dossier routing: gyn.ovarian-torsion.v1 (ddx — sudden severe unilateral pain), ob.ectopic-pregnancy.v1 (ddx — always β-hCG first), gi.acute-appendicitis (ddx — if dossier exists), id.sepsis.core.v1 (sepsis features routing), id.hiv-initial.chronic.v1 (HIV coinfection management coordination). Phenotype matrix (severity × TOA presence yes/no × TOA size < 5 / 5-7 / ≥ 8 cm × pregnancy yes/no × pathogen (N. gonorrhoeae / C. trachomatis / M. genitalium / anaerobic / mycoplasma / mixed / unidentified) × recurrent yes/no × HIV co-infection × prior IUD insertion < 3 wk × pelvic surgery recent) encoded indirectly via severity_triggers + per-setting playbook drug logic + sibling_differentiation. First-class TS field for phenotype matrix is schema-blocked (cross-shard). GAPS: dedicated PID manifest deferred to Phase D (currently reuses sepsis manifest per shard precedent); RxCUI verification (npm run research:rxnav:validate) pending; dedicated PID duration test (14-d course) pending; M. genitalium macrolide-resistance pathway test pending. Prehospital pattern: sudden severe pelvic pain + sepsis features → EMS large-bore IV + pre-notify ED + gyn-on-call (encoded via severity_triggers). Registry registration (_registry.ts import) deferred to subsequent batch chore commit per shard-5 refined pattern (main session batches registry, this commit is dossier-only). 3-file set: dossier TS + brief MD + research-bundle MD.