When should I consider referring a patient with PID to secondary care for further management?

Consider urgent hospital admission or referral to secondary care for a patient with pelvic inflammatory disease (PID) if any of the following apply:

• The woman is pregnant or an ectopic pregnancy is suspected.
• There are severe systemic symptoms such as nausea, vomiting, or fever above 38°C.
• An adnexal mass is present, suggesting complications like a tubo-ovarian abscess or pelvic peritonitis.
• The woman is systemically unwell and the diagnosis is uncertain.
• The woman is unable to tolerate or follow management in primary care.
• There is suspicion of complications such as perihepatitis.
• There is any uncertainty about clinical management.

Additionally, consider seeking specialist advice if:

• The woman has HIV infection.
• An intrauterine contraceptive device (IUD) is in situ with actinomyces-like organisms detected on cervical cytology.

If hospital admission or referral is not indicated, strongly recommend referral to a specialist sexual health service for STI screening, treatment, and partner notification.

Review the patient within 72 hours of starting treatment; if there is no clinical improvement, reassess and consider urgent hospital admission.