Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders of the upper female genital tract. A PVD plus cervical motion tenderness/uterine tenderness/adnexal tenderness should be present

Grading of PID (Gainesville)

Grade I: Acute salpingitis without peritonitis
Grade II: Acute salpingitis with peritonitis
Grade III: Acute salpingitis with tubo-ovarian complex or tubal occlusion
Grade IV: Ruptured tubo-ovarian complex and/or generalized peritonitis

N. gonorrhoeae and C. trachomatis

Microorganisms that comprise the vaginal flora e.g., anaerobes, G. vaginalis, Haemophilus influenzae, enteric Gram-negative rods, and Streptococcus agalactiae) have been associated with PID

Grade I

• Ceftriaxone 1g IM stat (diluted in 0.9ml lidocaine 1%), plus Doxycycline 100 mg orally twice daily for 14 days, plus Metronidazole 400 mg orally twice daily for 14 days
• Azithromycin 1G stat (repeated after 1 week) is an alternative to doxycycline.

Grade II-IV

• May warrant admission for IV Antibiotics and possible surgical intervention
• Consult Gynae Team if any clinical concerns ie. Fever, tachycardia etc. Q-Sofa score ≥ 1
• Amoxicillin- clavulanate 1.2g 8hrly ivi

Second line Therapy:

• Piperacillin - Tazobactam – ONLY In consultation with AMS Committee

On Discharge to complete a course of Metronidazole and Doxycycline for 7 days.