History
• As above, plus abdominal/back pain, fever/systemic sxs
Physical Exam
• Abdominal exam: Abdominal tenderness; RUQ tenderness (Fitz-Hugh–Curtis syndrome)
• Speculum: Cervical inflammation/d/c
• Bimanual: Cervical motion tenderness, adnexal mass/tenderness
Evaluation
• Labs: GC/Chlamydia testing, CBC, blood cultures if suspected sepsis
• Imaging: Pelvic U/S ± CT if concern for TOA
Treatment
• Abx: Ceftriaxone 250 mg IM × 1 AND (doxycycline 100 mg PO BID OR azithromycin 1 g qwk × 14 d) OR cefoxitin 2 g IV q6h OR cefotetan 2 g IV q12h AND doxycycline 100 mg PO/IV q12h OR clindamycin 900 mg IV q8h AND gentamicin 2 mg/kg IV × 1 then 1.5 mg/kg q8h
• Consult: Gyn service if concern for TOA
Disposition
• Home: Reliable pts w/ simple PID
• Admit: Tubo-ovarian abscess, pregnant, unable to tolerate POs