Pelvic inflammatory disease - Revision history

Aidan: Text replacement - " species]]" to "]]"

2022-01-25T17:02:56Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 17:02, 25 January 2022
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	***[[Ureaplasma urealyticum]]		***[[Ureaplasma urealyticum]]
	**Anaerobes		**Anaerobes
	***[[Bacteroides ~~species~~]]		***[[Bacteroides]]
	***[[Peptostreptococcus ~~species~~]]		***[[Peptostreptococcus]]
	***[[Prevotella ~~species~~]]		***[[Prevotella]]
	**Aerobes		**Aerobes
	***[[Escherichia coli]]		***[[Escherichia coli]]
	***[[Gardnerella vaginalis]]		***[[Gardnerella vaginalis]]
	***[[Haemophilus influenzae]]		***[[Haemophilus influenzae]]
	***[[Streptococcus ~~species~~]]		***[[Streptococcus]]

	===Epidemiology===		===Epidemiology===

Aidan: /* Management */

2021-06-20T20:55:57Z

Management

← Older revision		Revision as of 20:55, 20 June 2021
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	***[[Is treated by::Ciprofloxacin]] 200 mg IV q12h plus [[Is treated by::doxycycline]] 100 mg IV/PO q12h ± [[Is treated by::metronidazole]] 500 mg IV q8h		***[[Is treated by::Ciprofloxacin]] 200 mg IV q12h plus [[Is treated by::doxycycline]] 100 mg IV/PO q12h ± [[Is treated by::metronidazole]] 500 mg IV q8h
	**Outpatient regimens		**Outpatient regimens
	***[[Is treated by::Ceftriaxone]] 250 mg IM once plus [[Is treated by::~~docycycline~~]] 100 mg PO bid for 14 days, ± [[Is treated by::metronidazole]] 500 mg IV q8h		***[[Is treated by::Ceftriaxone]] 250 mg IM once plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[Is treated by::metronidazole]] 500 mg IV q8h
	***[[Is treated by::Cefoxitin]] 2 g IM once plus [[Is treated by::probenecid]] 1 g po once plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[metronidazole]] 500 mg IV q8h		***[[Is treated by::Cefoxitin]] 2 g IM once plus [[Is treated by::probenecid]] 1 g po once plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[metronidazole]] 500 mg IV q8h
	***Another third-generation cephalosporin plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[metronidazole]] 500 mg IV q8h		***Another third-generation cephalosporin plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[metronidazole]] 500 mg IV q8h

Aidan: /* Management */

2021-04-12T01:31:52Z

Management

← Older revision		Revision as of 01:31, 12 April 2021
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	==Background==		==Background==

	* Upper genital tract infection in women that involves infection of any combination of endometrium, fallopian tubes, and peritoneum		*Upper genital tract infection in women that involves infection of any combination of endometrium, fallopian tubes, and peritoneum

	===Microbiology===		===Microbiology===
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	**Diagnosed [[gonorrhea]] or [[chlamydia]]		**Diagnosed [[gonorrhea]] or [[chlamydia]]

	=== Complications ===		===Complications===

	* Short-term:		*Short-term:
	** [[Fitz-Hugh-Curtis syndrome]]		**[[Fitz-Hugh-Curtis syndrome]]
	** [[Tubo-ovarian abscess]]		**[[Tubo-ovarian abscess]]
	* Long-term:		*Long-term:
	** [[Ectopic pregnancy]]		**[[Ectopic pregnancy]]
	** [[Infertility]]		**[[Infertility]]
	** [[Chronic pelvic pain]]		**[[Chronic pelvic pain]]

	== Differential Diagnosis ==		==Differential Diagnosis==

	* Gynecologic/obstetrical		*Gynecologic/obstetrical
	** Complications of pregnancy		**Complications of pregnancy
	*** Ectopic pregnancy		***Ectopic pregnancy
	** Endometriosis		**Endometriosis
	** Endometritis		**Endometritis
	** Adnexal disorders		**Adnexal disorders
	** Mentrual disorders		**Mentrual disorders
	* Gastrointestinal		*Gastrointestinal
	** [[Appendicitis]]		**[[Appendicitis]]
	** [[Gastroenteritis]]		**[[Gastroenteritis]]
	** [[Inflammatory bowel disease]]		**[[Inflammatory bowel disease]]
	* Genitourinary		*Genitourinary
	** [[Cystitis]]		**[[Cystitis]]
	** [[Pyelonephritis]]		**[[Pyelonephritis]]
	** [[Nephrolithiasis]]		**[[Nephrolithiasis]]
	* Musculoskeletal causes		*Musculoskeletal causes
	* Neurologic causes		*Neurologic causes

	==Investigations==		==Investigations==
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	**Ideally done as transvaginal ultrasound		**Ideally done as transvaginal ultrasound

	== Diagnosis ==		==Diagnosis==

	* Definitive diagnosis is rarely obtained; more commonly, the disease is treated based on clinical findings		*Definitive diagnosis is rarely obtained; more commonly, the disease is treated based on clinical findings
	* Definitive diagnostic criteria include:		*Definitive diagnostic criteria include:
	** Endometrial biopsy with evidence of endometritis		**Endometrial biopsy with evidence of endometritis
	** Transvaginal ultrasound showing thickened fluid-filled tubes, with or without free pelvic fluid or tubo-ovarian complex		**Transvaginal ultrasound showing thickened fluid-filled tubes, with or without free pelvic fluid or tubo-ovarian complex
	** Laparoscopy showing findings of PID, including fallopian tube erythema or mucopurulent exudates		**Laparoscopy showing findings of PID, including fallopian tube erythema or mucopurulent exudates

	==Management==		==Management==
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	*There are many possible regimens		*There are many possible regimens
	**[[Fluoroquinolones]] and [[doxycycline]] are contraindicated in pregnancy and breastfeeding		**[[Fluoroquinolones]] and [[doxycycline]] are contraindicated in pregnancy and breastfeeding
	**Often recommended to add [[Is treated by::metronidazole]] to any regimen that does not have adequate anaerobic coverage, ~~though~~ it is ~~unclear whether this makes any difference~~		**Often recommended to add [[Is treated by::metronidazole]] to any regimen that does not have adequate anaerobic coverage, which likely improves outcomes[[CiteRef::wiesenfeld2020a]]
	**Only consider [[fluoroquinolones]] if there is susceptibility testing done or a test of cure is possible		**Only consider [[fluoroquinolones]] if there is susceptibility testing done or a test of cure is possible
	**First-line regimens		**First-line regimens

Aidan at 20:29, 18 September 2020

2020-09-18T20:29:14Z

Show changes

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T16:32:49Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 16:32, 14 July 2020
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	* About 10-15% of women have at least one episode		* About 10-15% of women have at least one episode

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Pelvic or abdominal pain is the main complaint		* Pelvic or abdominal pain is the main complaint
	* May be febrile and have adnexal, uterine, or cervical motion tenderness		* May be febrile and have adnexal, uterine, or cervical motion tenderness

Aidan: /* Investigations */

2019-11-11T19:38:45Z

Investigations

← Older revision		Revision as of 19:38, 11 November 2019
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	== Investigations ==		== Investigations ==
	* β-hCG to rule out ectopic pregnancy		* β-hCG to rule out ectopic pregnancy
	* Endocarvical swabs for gonorrhea and chlamydia, and possibly HSV		* Endocarvical swabs for [[gonorrhea]] and [[chlamydia]], and possibly HSV
	* Vaginal swabs for culture, pH, whiff testing, wet preps, and Gram stain		* Vaginal swabs for culture, pH, whiff testing, wet preps, and Gram stain
	* Ultrasound can be helpful, especially for tuboovarian abscess		* Ultrasound can be helpful, especially for tuboovarian abscess

Aidan: /* Management */ finished a sentence

2019-11-11T00:58:36Z

Management: finished a sentence

← Older revision		Revision as of 00:58, 11 November 2019
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	** [[Is treated by::Ofloxacin]] 400 mg PO bid for 14 days, ± [[Is treated by::metronidazole]] 500 mg IV q8h		** [[Is treated by::Ofloxacin]] 400 mg PO bid for 14 days, ± [[Is treated by::metronidazole]] 500 mg IV q8h
	** [[Is treated by::Levofloxacin]] 500 mg PO daily, ± [[Is treated by::metronidazole]] 500 mg IV q8h		** [[Is treated by::Levofloxacin]] 500 mg PO daily, ± [[Is treated by::metronidazole]] 500 mg IV q8h
	* Often recommended to add [[Is treated by::metronidazole]] to any of the above regimens that do not have		* Often recommended to add [[Is treated by::metronidazole]] to any of the above regimens that do not have adequate anaerobic coverage, though it is unclear whether this makes any difference
	* Only consider fluoroquinolones if there is susceptibility testing done or a test of cure is possible		* Only consider fluoroquinolones if there is susceptibility testing done or a test of cure is possible
	* If an intrauterine device is in situ, remove it only after at least 2 doses of antibiotics have been given		* If an intrauterine device is in situ, remove it only after at least 2 doses of antibiotics have been given

Aidan: Initial page creation

2019-11-11T00:57:27Z

Initial page creation

New page

* Upper genital tract infection in women that involves a combination of endometrium, fallopian tubes, and peritoneum

== Background ==
=== Microbiology ===
* Often polymicrobial
* Most commonly associated with [[Chlamydia trachomatis]] or [[Neisseria gonorrhoeae]]
* May also involve [[Mycoplasma hominis]], [[Mycoplasma genitalium]], [[Ureaplasma urealyticum]], [[Escherichia coli]], [[Gardnerella vaginalis]], [[Streptococcus species]], [[Haemophilus influenzae]], [[Bacteroides species]], [[Prevotella species]], [[Trichomonas vaginalis]], and [[Herpes simplex virus]]

=== Epidemiology ===
* About 10-15% of women have at least one episode

== Clinical Presentation ==
* Pelvic or abdominal pain is the main complaint
* May be febrile and have adnexal, uterine, or cervical motion tenderness
* Must rule out an ectopic pregnany
* May present with tuboovarian abscess

== Investigations ==
* β-hCG to rule out ectopic pregnancy
* Endocarvical swabs for gonorrhea and chlamydia, and possibly HSV
* Vaginal swabs for culture, pH, whiff testing, wet preps, and Gram stain
* Ultrasound can be helpful, especially for tuboovarian abscess

== Management ==
* There are many possible regimens
** [[Is treated by::Cefoxitin]] 2 g IV q6h plus [[Is treated by::doxycycline]] 100 mg IV/PO q12h, stepped down to oral [[doxycycline]] once clinical improvement to complete 14 days
** [[Is treated by::Clindamycin]] 900 mg IV q8h plus [[Is treated by::gentamicin]] 2mg/kg loading dose then 1.5 mg/kg q8h maintenance dose (or 5 mg/kg q24h dosing), steped down to [[Is treated by::doxycycline]] or [[Is treated by::clindamycin]] 450 mg PO qid to complete 14 days
** [[Is treated by::Ofloxacin]] 400 mg IV q12h or [[Is treated by::levofloxacin]] 500 mg IV daily, ± [[Is treated by::metronidazole]] 500 mg IV q8h
** [[Is treated by::Ampicillin-sulbactam]] 3 g IV q6h plus [[Is treated by::doxycycline]] 100 mg IV/PO q12h
** [[Is treated by::Ciprofloxacin]] 200 mg IV q12h plus [[Is treated by::doxycycline]] 100 mg IV/PO q12h ± [[Is treated by::metronidazole]] 500 mg IV q8h
** [[Is treated by::Ceftriaxone]] 250 mg IM once plus [[Is treated by::docycycline]] 100 mg PO bid for 14 days, ± [[Is treated by::metronidazole]] 500 mg IV q8h
** [[Is treated by::Cefoxitin]] 2 g IM once plus [[Is treated by::probenecid]] 1 g po once plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[metronidazole]] 500 mg IV q8h
** Another third-generation cephalosporin plus [[Is treated by::doxycycline]] 100 mg PO bid for 14 days, ± [[metronidazole]] 500 mg IV q8h
** [[Is treated by::Ofloxacin]] 400 mg PO bid for 14 days, ± [[Is treated by::metronidazole]] 500 mg IV q8h
** [[Is treated by::Levofloxacin]] 500 mg PO daily, ± [[Is treated by::metronidazole]] 500 mg IV q8h
* Often recommended to add [[Is treated by::metronidazole]] to any of the above regimens that do not have
* Only consider fluoroquinolones if there is susceptibility testing done or a test of cure is possible
* If an intrauterine device is in situ, remove it only after at least 2 doses of antibiotics have been given

== Further Reading ==
* [https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sexually-transmitted-infections/canadian-guidelines-sexually-transmitted-infections-22.html Management and treatment of specific syndromes – Pelvic Inflammatory Disease (PID)]. Canadian Guidelines on Sexually Transmitted Infections.

[[Category:Genitourinary infections]]