Pocket ObGyn – Pelvic Inflammatory Disease (PID)
See Abbreviations
Definition and Epidemiology (Obstet Gynecol 2010;116:419)
- PID: Clinical spectrum of inflamm disorders of the female upper genital tract including endometritis, salpingitis, TOA, & pelvic peritonitis
- >800000 cases/y in US; true magnitude unk due to difficult dx
- Risk factors: Age <25, young age at 1st intercourse, nonbarrier contraception, multi sexual partners, oral contraception, cervical ectopy, IUD insertion w/i prev 3 w
Etiology and Microbiology (NEJM 1975;293:166; Ann Intern Med 1981;95:685)
- Neisseria gonorrhoeae: 1/3 of cases; 15% w/ endocervical gonorrhea develop PID
- trachomatis: 1/3 of cases; 15% w/ endocervical chlamydia develop PID
- Other pathogens: Vaginal flora (eg, anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric gram-negative rods, & Streptococcus agalactiae)
Clinical Manifestations
- Lower abdominal pain (90%). Mucopurulent discharge (75%).
- Long-term sequelae: Infertility (18%), ectopic Preg, chronic pelvic pain, dyspareunia
| Diagnosis of PID | |
| CDC diagnostic criteria (Dx is imprecise. Maintain low threshold for rx due to long-term sequelae.) | 1. Pelvic or lower abdominal pain |
| 2. No cause other than PID can be identified | |
| 3. 1 or more minimum criteria are present on physical exam: (a) cervical motion tenderness, (b) uterine tenderness, or (c) adnexal tenderness | |
| Additional criteria (enhance spec) | 1. Oral temp. >101°F (>38.3°C) |
| 2. Abn cervical or vaginal mucopurulent discharge | |
| 3. Presence of abundant # of WBCs on wet mount | |
| 4. Elevated ESR | |
| 5. Elevated CRP | |
| 6. +GC/CT | |
| 7. Lab-proven chlamydia or gonorrhea infxn | |
| Specific criteria (if needed) | Endometrial bx w/ endometritis
TV sono or MRI w/ hydrosalpinx or free pelvic fluid Laparoscopic confirmation of pelvic infxn |
| From CDC. Sexually Transmitted Diseases Treatment Guidelines, 2010. http://www.cdc.gov/std/ treatment/2010/pid.htm. | |
Treatment
- Indications for hospitalization: Preg, outpt therapy failure after 72 h, noncompliance, sev illness (eg, N/V, high fever), or TOA
- IUD: Do not need to remove IUD, close clinical f/u if remains in place
- Screen for additional STIs. F/u in clinic in 3 d
- EPT is indicated to prevent reinfection: See state-specific legislation: http://www.cdc. gov/std/ept/legal/default.htm
| CDC 2010 treatment guidelines | ||
| Inpt | Cefotetan 2 g IV q12h OR Cefoxitin 2 g IV q6h +
Doxycycline 100 mg PO or IV q12h ´ 14 d |
D/c parenteral rx 24 h after clinical improv & afebrile |
| Clindamycin 900 mg IV q8h + Gentamicin IV or IM (2 mg/kg) ´1, then 1.5 mg/kg q8h | ||
| Outpt | Ceftriaxone 250 mg IM* ´1 OR
Cefoxitin 2 g IM ´1 & Probenecid 1 g PO ´1 + Doxycycline 100 mg PO q12h ´ 14 d & ± Metronidazole 500 mg PO q12h ´ 14 d |
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| *Note: Oral cephalosporins no longer recommended to treat gonorrhea due to growing resistance (as high as 6%) in some states. CDC. MMWR. 2012;61(31):590.
From CDC. Sexually Transmitted Diseases Treatment Guidelines, 2010. http://www.cdc.gov/std/ treatment/2010/pid.htm. |
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