How should I manage a patient with gonorrhoea who is also presenting with symptoms of pelvic inflammatory disease?

Management of a patient with gonorrhoea presenting with symptoms of pelvic inflammatory disease (PID):

• Refer the patient to a genito-urinary medicine (GUM) clinic or local specialist sexual health service for comprehensive management, including STI screening, treatment, and partner notification. If the patient is unwilling or unable to attend, management can be undertaken in primary care if appropriate expertise and local protocols are available ².
• Prescribe antibiotic treatment that covers Neisseria gonorrhoeae and other aerobic and anaerobic bacteria associated with PID. The recommended regimen for suspected gonococcal PID is a single intramuscular (IM) dose of ceftriaxone 1 g, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days ¹.
• Oral cephalosporins such as cefixime are not recommended due to lower tissue levels and lack of evidence; IM ceftriaxone is preferred to maximize tissue penetration and overcome resistance ¹.
• Avoid quinolone antibiotics (e.g., ofloxacin, moxifloxacin) in patients at high risk of gonococcal PID due to high resistance levels ¹.
• Advise the patient to abstain from all sexual activity until both they and their sexual partner(s) have completed treatment, are symptom-free, and have had a test of cure if indicated ¹.
• Arrange follow-up within 72 hours to assess clinical response; if no improvement, reassess diagnosis, check treatment compliance, and consider urgent hospital admission ¹.
• Ensure partner notification and treatment to prevent reinfection ³.
• Arrange a test of cure 2–4 weeks after completion of treatment for gonorrhoea ¹.