OB/GYN consult for possible operative drainage
Majority (60-80%) resolve with antibiotics alone
Predictors of antibiotic treatment failure and possible indications for IR drainage upon admission to Ob
WBC > 16,000<unk>  size > 5.2 cm
WBC > 16,000<unk>  size > 5.2 cm
No sexual activity for 2 weeks;
Treat all partners who had sex with patient during previous 60 days prior to symptom onset
Ceftriaxone 500mg IM (1g if >150kg) x1 + doxycycline 100mg PO BID x14d + metronidazole 500mg PO BID x14d 
Metronidazole
Recommended for empiric treatment of PID by the CDC 
Recommended empirically by European guidelines 
Cefoxitin 2 g IM in a single dose and Probenecid, 1 g PO administered concurrently in a single dose + Doxycycline 100 mg PO BID x 14 days + metronidazole
Metronidazole
Recommended for empiric treatment of PID by the CDC 
Recommended empirically by European guidelines 
Recommended for empiric treatment of PID by the CDC 
Recommended empirically by European guidelines 
Recommended: Ceftriaxone 1gm IV q24hr OR Cefoxitin 2gm IV q6hr OR cefotetan 2gm IV q12hr) + doxycycline PO or IV 100 mg q12hr + Metronidazole 500mg IV or PO Q12hr OR
Clindamycin 900mg IV q8h + gentamicin 2mg/kg loading -> 1.5 mg/kg q8hr IV OR
Ampicillin-sulbactam 3gm IV q6hr + doxycycline 100mg IV/PO q12hr
Tubo-ovarian abscess
Pelvic origin
Ovarian cyst
Acute cystitis
Ovarian torsion
Ectopic
Ectopic pregnancy
Spermatocele