GuidelinesOther guideline
Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease
Diagnosis
Staging and manifestation
Medical treatment
PID is an infectious disorder of the upper female reproductive tract initiated by infection that ascends from the vagina and cervix.
Organisms implicated in the pathogenesis of PID include:
- Chlamydia trachomatis
- Neisseria gonorrhoea
- Gardnerella vaginalis
- Haemophilus influenza
- E.coli
- Anaerobes
Diagnosis
Have a low threshold for diagnosis in sexually active women at risk for STI with pelvic or LAP.
Criteria improving diagnostic specificity:
- Temp > 38.3
- Mucopurulent PV discharge
- TV ultrasound showing thickened fluid filled tubes, fluid in P.O.D or tubo-ovarian abscess.
Staging and manifestation
| Stage | Manifestations |
| Stage I | Cervical motion tenderness and/ or uterine tenderness and/ or adnexal tenderness |
| Stage II | As above plus pelvic peritonitis |
| Stage III | As above plus tubo-ovarian complex or abscess |
| Stage IV | Generalised peritonitis Ruptured tubo-ovarian complex Septicaemia |
Treatment goals:
- Relieve acute symptoms
- Eradicate current infection
- Minimise long –term sequelae (infertility, ectopic pregnancy, chronic pain)
Criteria for hospitalisation:
- All patients with stage II–IV PID for parenteral antibiotics.
- Pregnancy
- Failure to improve clinically after 72 hours of outpatient therapy.
- Inability to tolerate oral antibiotics
- Severe illness or nausea and vomiting
Medical Treatment
| Stage | Medication |
| Stage I | Azithromycin 1g po stat AND Ceftriaxone 250 mg IM stat - dissolve with 0.9mls lignocaine 1% without adrenaline AND Metronidazole 400mg po 12 hourly x 7/7 |
| Stages II –IV | Ceftriaxone, IV, 1g daily AND Metronidazole IV, 500mg 8 hourly Continue intravenous therapy until there is definite clinical improvement (within 24-48 hours) Thereafter, change to: Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly to complete 10 days therapy AND Azithromycin 1g po stat (to treat chlamydia) |
| Stages II –IV (in penicillin allergy) | Clindamycin, IV, 600mg 8 hourly AND Gentamicin, IV, 6 mg/kg daily Continue intravenous therapy until there is definite clinical improvement (within 24-48 hours) Thereafter, change to: Clindamycin 450mg po 8 hourly AND Ciprofloxacin 500mg po 12 hourly to complete 10/7 therapy AND Azithromycin 1g po stat (to treat chlamydia) |
Stages III and IV should be managed in consultation with a gynaecologist.
- Patients not improving within 72 hours should be re-evaluated for possible surgical intervention.
- Patients should be advised to notify their partners and should be encouraged to test for HIV infection.