LAP — Key Facts & Diagnosis

Clinical description

• Main symptoms: lower abdominal/pelvic pain, often bilateral. ± vaginal discharge, irregular menstrual bleeding, dyspareunia, dysuria, fever/chills.
• Wide range of causes: PID (STI and non-STI), gynaecological/obstetric (ectopic pregnancy, abortion, ovarian cyst), surgical (appendicitis, diverticulitis), UTI, gastroenteritis.
• Danger signs: missed period (ectopic?), recent delivery/abortion/miscarriage, fever >38 °C, palpable mass, heavy bleeding. → urgent OB-GYN/surgical referral.
• Syndromic PID treatment covers all common STI and non-STI causes given the potential severity and difficulty identifying the underlying cause.

Treatment

With abdominal tenderness / cervical excitation / vaginal discharge

• Ceftriaxone 500 mg IM stat.
• Azithromycin 1000 mg oral stat.
• Metronidazole 400 mg oral BD for 14 days.
• Doxycycline 100 mg oral BD for 14 days. (Avoid in PBFW and children.)

Mild/no abdominal tenderness

• Metronidazole 400 mg oral BD for 5 days.
• If thick/cream discharge, burning/swelling: add clotrimazole 500 mg vaginal pessary stat.

Always give a 3-day review appointment. If not improved: speculum exam for cervicitis, refer for labs (NG, CT, TV), add praziquantel 40 mg/kg oral stat, ensure partner treatment.

Partner treatment

Partner treatment (asymptomatic)

• Ceftriaxone 500 mg IM stat + azithromycin 1000 mg oral stat + doxycycline 100 mg oral BD for 14 days.

At every visit

HIV & ART status

• Ascertain HIV + ART status from health passport or self-report.
• Offer new HIV test for all unless previously diagnosed. Do not use coercion.
• New positive: active referral for ART initiation.
• New negative: refer/offer PrEP, VMMC, consistent condom use.
• Known positive: reinforce ART adherence or refer for re-initiation.

Hepatitis B

• Offer HBV rapid test for all patients born before 2002.
• HBsAg negative: refer for HBV vaccination unless previously completed 3 doses.
• HBsAg positive: refer for clinical and treatment assessment.

Syphilis screening

• Offer syphilis rapid test for concurrent asymptomatic syphilis (except in GUD/ARI where it does not influence treatment decisions).

Risk reduction & condoms

• Risk reduction counselling. Promote and dispense condoms.
• Promote VMMC for all non-circumcised men. Schedule appointment in 2 weeks.