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HPI 25 yoWF c/o lower abd pain.

PE:Pregnancy testCBC Chem7 Endocervical gram stain-for gram-negative intracellular diplococciEndocervical culture-for gonorrhea Endocervical culture or antigen test-for chlamydia

TREATMENT:Outpatient, normallyHospitalization recommended in the following situations:Uncertain diagnosisSurgical emergencies cannot be excluded, e.g., appendicitisSuspected pelvic abscess Pregnancy Adolescent patient with uncertain compliance with therapy Severe illness Cannot tolerate outpatient regimenFailed to respond to outpatient therapyClinical follow-up within 72 hours of starting antibiotics cannot be arrangedHIV-infected

GENERAL MEASURES Avoidance of sex until treatment is completedInsure that sex partners are referred for appropriate evaluation and treatment. Partners should be treated, irrespective of evaluation, with regimens effective against chlamydia and gonorrhea.

SURGICAL MEASURES Reserved for failures of medical treatment and for suspected ruptured adnexal abscess with resulting acute surgical abdomenInpatient treatment; Cefoxitin IV cefotetan IV (or other cephalosporins such as ceftizoxime, cefotaxime, and ceftriaxone) plus doxycycline orally or IV Therapy for 24 hours after clinical improvement and doxycycline continued after discharge for a total of 10-14 daysClindamycin plus gentamicin loading dose IV or IM Therapy for 24 hours after clinical improvement with doxycycline after discharge as aboveOutpatient treatmentceftriaxone plus doxycycline orally for 10-14 daysOfloxacin orally for 14 days plus either clindamycin orally or metronidazole

PATIENT MONITORING Close observation of clinical status, in particular for fever, symptoms, level of peritonitis, white cell countsafe sex practices education-particularly for those who have had an episode of PID

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