Patient handout

Pelvic inflammatory disease (PID) + tubo-ovarian abscess (TOA)

PRODUCTION

1. Your condition

This handout is for pelvic inflammatory disease (pid) + tubo-ovarian abscess (toa). Your care team identified this based on: pelvic / lower abdominal pain in sexually active reproductive-age female (cdc sti 2021 minimum criterion).

Other reasons your team may use this plan: cervical motion tenderness or uterine tenderness or adnexal tenderness on bimanual exam (cdc sti 2021 minimum criterion ≥ 1); mucopurulent cervical discharge or cervical friability (cdc sti 2021 additional criterion improves specificity); lab-confirmed n. gonorrhoeae / c. trachomatis / m. genitalium on cervical naat with pelvic symptoms (cdc sti 2021 additional criterion).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ceftriaxone	500 mg IM	IM	single dose	CDC STI 2021 — single IM dose covers N. gonorrhoeae + drives empiric coverage for outpatient PID
doxycycline	100 mg PO	PO	BID × 14 d	CDC STI 2021 — covers C. trachomatis + atypicals + most M. genitalium (if not macrolide-resistant)
metronidazole	500 mg PO	PO	BID × 14 d	CDC STI 2021 — added 2021 to cover anaerobes + bacterial vaginosis-associated pathogens (vs 2015 guidance which made it optional)
moxifloxacin	400 mg PO	PO	daily × 14 d	CDC STI 2021 — M. genitalium-confirmed PID with macrolide resistance

Plan: Outpatient mild-moderate PID (no TOA, tolerating PO, reliable 72-h follow-up) — CDC STI 2021

3. When to call your provider

Contact your care team if any of the following happen:

No improvement at 72 h on outpatient regimen → admit + IV + repeat TVUS / CT for TOA + broaden coverage (CDC STI 2021; ACOG PB 232)
TOA detected on imaging → admit + IV antibiotics + drainage decision (ACOG PB 232)
Pregnancy with PID → admit immediately + ceftriaxone IV + azithromycin + MFM consult (avoid doxycycline) (ACOG PB 232; CDC STI 2021)
Sepsis features (hypotension, lactate elevation, tachycardia, AMS) → ED + SSC 2026 Hour-1 bundle; routes to id.sepsis.core.v1 (SSC 2021)
Cannot tolerate PO / vomiting → ED for IV + admission (CDC STI 2021)
M. genitalium macrolide-resistant → switch to moxifloxacin pathway (CDC STI 2021)
HIV co-infection with severe PID → lower admission threshold per CDC STI 2021
Recurrent PID (≥ 2 episodes) → reproductive endocrinology referral + partner-treatment-adherence review + chronic-pelvic-pain workup (CDC STI 2021)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

TVUS / CT-confirmed tubo-ovarian abscess at diagnosis — admit + IV antibiotics + drainage decision based on size and response (ACOG PB 232; CDC STI 2021)
Suspected TOA rupture: peritonitis + free fluid on imaging + sepsis features — emergent OR / laparoscopy + broad-spectrum + ICU (ACOG PB 232; SSC 2021)(life-threatening)
PID diagnosed in pregnant patient — rare but mandates admission, IV antibiotics, MFM consult, avoid doxycycline (ACOG PB 232; CDC STI 2021)
Persistent fever / pain / tenderness at 72 h after appropriate outpatient regimen — admit for IV + repeat imaging for missed TOA + broaden coverage (CDC STI 2021)
PID with hypotension on adequate fluids + lactate > 2 OR qSOFA ≥ 2 + skin / pelvic source — routes to id.sepsis.core.v1 + SSC 2021 hour-1 bundle (SSC 2021; CDC STI 2021)(life-threatening)
PID with confirmed M. genitalium + macrolide resistance — switch from doxycycline to moxifloxacin 400 mg PO daily × 14 d (CDC STI 2021)
PID in HIV-positive patient — same regimens as non-HIV but higher TOA risk, lower admission threshold per CDC STI 2021

5. Follow-up

3-month retest for GC / CT for repeat infection (per CDC STI 2021). Partner treatment within 60 d via expedited partner therapy where legal. Fertility counseling — recurrent-PID linkage to reproductive endocrinology. Chronic pelvic pain management. Repeat HIV / syphilis testing per CDC STI 2021. Counsel on long-term sequelae (infertility 12-50 % cumulative, ectopic 6-10×, chronic pelvic pain 30-40 %).

6. Sources

Guideline: CDC STI Treatment Guidelines 2021 (Workowski MMWR Recomm Rep 2021 PMID 34292926) + ACOG Practice Bulletin 232 (2021) — Pelvic Inflammatory Disease + WHO STI Treatment 2021 + PEACH long-term outcome trial (Ness Am J Obstet Gynecol 2002 PMID 12015499) + CDC 2024 STI Treatment update (anticipated cycle — PMID NEEDS_SOURCE_REVIEW)