Background
PID is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women.
Chlamydia trachomatis and Neisseria gonorrhoeae are the most common organisms involved; however, other microorganisms especially anaerobes are often involved.
Diagnosis
The diagnosis of PID is based primarily on clinical evaluation. Significant consequences occur if treatment is delayed. Don’t wait for NAAT for Chlamydia and Gonorrhea.
Treatment
Antibiotics to cover chlamydia, gonorrhea, and anaerobes.
-Outpatient: Ceftriaxone 250mg IM or IV x1 AND Metronizadole 500mg po BID x 14d PLUS Doxycycline 100mg po BID x 14d.
-Inpatient: Cefoxitin 2gm IV q6h plus Doxycycline 100mg IV BID for 14 days.
Empiric treatment is started as soon as the diagnosis of PID is suspected to minimize the risk of sequelae such as tubal obstruction and infertility.
Epithelial damage from infections such as Chlamydia trachomatis or Neisseria gonorrhoeae may allow opportunistic infection from many other bacteria particularly anaerobes.
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“Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including chronic pelvic pain, ectopic pregnancy, and infertility. Hospitalization and parenteral treatment are recommended if the patient is pregnant, has HIV infection, does not respond to oral medication, or is severely ill. Strategies for preventing pelvic inflammatory disease include routine screening for chlamydia and patient education.” Am Fam Physician. 2012 Apr 15;85(8):791-796.
Source:
http://www.aafp.org/afp/2014/1115/p725.html
http://www.aafp.org/afp/2012/0415/p791.html