Differential diagnosis

  • PID – fever, lower abdo pain, dyspareunia (deep), PV discharge, IMB/PCB, fever
  • Reactive arthritis – joints, eyes


Data gathering

  • Red flags – abdo pain, IMB, PCB, LMP, fever
  • Others – discharge, dysuria, dyspareunia, itching, sores
  • Examine – abdominal exam, speculum, vagina, lymph nodes


Clinical management

  • Investigations
    • Endocervical swabs (or vaginal self swab or first void urine) – chlamydia, gonorrhoea
    • Vaginal swab – candida, BV
    • (men – first void urine for chlamydia and gonorrhoea and rectal swabs from MSM)
    • Bloods – HIV, syphilis
  • Explanation
    • chlamydia is often without symptoms but it is important to treat as infection can spread in your body and cause serious complications and you can pass it to others. Condoms are the only way to prevent STIs.
  • Treatment
    • Antibiotics e.g. azithromycin 1g stat – avoid sex for 7d after treatment
    • Contact tracing
    • Pregnancy test (test for cure of chlamydia treatment if pregnant)
  • Follow-up / Safety-net
    • local sexual health clinic for more detailed screening
    • PIL


  • Annual screening for all sexually active people under 25y
  • Complications – subfertility, ectopic, PID