Pelvic Inflammatory Disease (PID) includes any inflammatory disorder of the female genital tract, including endometritis, salpingitis, tubo-ovarian abscess, or pelvic peritonitis. Historically, it was thought that sexually transmitted organisms, especially N. gonorrhoeae and C. trachomatis, were implicated in up to 50% of clinical cases diagnosed; however, recent reports show that the proportion of PID cases attributable to a specific organism is decreasing. More often, bacterial vaginosis (BV) and microorganisms that comprise the vaginal flora, such as G. vaginalis, H. influenzae, enteric gram-negative rods, and Streptococcus agalactiae, have been associated with symptoms
There should be a low threshold to treat. Recommendations include that presumptive treatment for PID should be initiated for sexually active women if they are experiencing pelvic or lower abdominal pain or if no cause for the illness other than PID can be identified. If one or more of the following three minimum clinical criteria are present on pelvic examination, such as (1) cervical motion tenderness (2) uterine tenderness, or (3) adnexal tenderness, then treatment is indicated
Oral/IM regimens
Note: Patients weighing >150 kg with documented gonococcal infection, treatment with 1 gram of ceftriaxone should be administered, not 500mg
Cephalosporin Allergy: If community prevalence and individual risk for gonorrhea are low, and follow-up is likely
Note: If a culture for gonorrhea is positive, treatment should be based on results of antimicrobial susceptibility testing | If isolate is quinolone-resistant N. gonorrhoeae or antimicrobial susceptibility cannot be assessed (e.g., if only NAAT testing is available), consultation with an infectious disease specialist is recommended
IV/Parenteral Regimens
Note: Doxycycline should be administered orally when possible due to pain with IV infusion and similar bioavailability both PO and IV. Similarly, metronidazole has similar IV and PO bioavailability and can be considered PO for women without severe illness or tubo-ovarian abscess
Timely treatment of suspected PID is warranted. Failure to clinically improve in 72 hours should prompt reconfirmation of the diagnosis and admission for intravenous antibiotic therapy. Transition to oral therapy can usually be accomplished within 24-48 hours of clinical improvement. Women should complete a 14 day regimen of antibiotics. They should be advised to abstain from sexual intercourse until symptoms have resolved, therapy has been completed, and partners have been treated, if needed. If tests for gonorrhea or chlamydia are positive, women should be retested 3 months after treatment
PID Diagnosis with IUD present
CDC 2021 PID Treatment Guidelines
University of Washington (CDC Funded): PID Self-Study Module for Clinicians
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