Pelvic inflammatory disease: Difference between revisions

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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

Revision as of 16:55, 20 June 2021

Background

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

Microbiology

Epidemiology

  • About 10-15% of women have at least one episode

Clinical Manifestations

  • Pelvic or abdominal pain is the main complaint
  • May be febrile and have adnexal, uterine, or cervical motion tenderness
  • May present with tubo-ovarian abscess
  • Minimum diagnostic criteria for treatment include lower abdominal pain, adnexal tenderness, and cervical motion tenderness
  • Additional supportive criteria include
    • Fever >38.3ºC
    • Presence of leukocytes on saline microscopy of vaginal secretions
    • Elevated ESR or CRP
    • Diagnosed gonorrhea or chlamydia

Complications

Differential Diagnosis

Investigations

  • No combination of routine investigations (including swabs and ultrasound) can be used to completely rule out PID
  • Laboratory 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
  • Radiography
    • Ultrasound can be helpful, especially for tuboovarian abscess
    • Ideally done as transvaginal ultrasound

Diagnosis

  • Definitive diagnosis is rarely obtained; more commonly, the disease is treated based on clinical findings
  • Definitive diagnostic criteria include:
    • Endometrial biopsy with evidence of endometritis
    • 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

Management

Further Reading

References

  1. ^  Harold C Wiesenfeld, Leslie A Meyn, Toni Darville, Ingrid S Macio, Sharon L Hillier. A Randomized Controlled Trial of Ceftriaxone and Doxycycline, With or Without Metronidazole, for the Treatment of Acute Pelvic Inflammatory Disease. Clinical Infectious Diseases. 2020;72(7):1181-1189. doi:10.1093/cid/ciaa101.