OGCO-E11 Recommendations for the dx and treatment of a cute pelvic inflammatory disease

Question 1

Clinical features suggestive of a dx of acute pelvic inflammatory disease

Answer 1

-lower abdominal pain and tenderness
-deep dyspareunia
-abnormal vaginal or cervical discharge
-cervical excitation and adnexal tenderness
-fever (>38°C)

Question 2

What are the suggested Ix for patients suspected of having PID?

Answer 2

-complete blood picture (leucocytosis)
-screening for sexually transmitted diseases:
endocervical swabs for gonococcus & chlamydia
high vaginal swab for trichomonas
serology for syphilis (VDRL) and HIV infection
-cervical smear (screening)
-urine pregnancy test (to exclude ectopic pregnancy)

Question 3

What antibiotics coverage is needed for PID?

Answer 3

Broad spectrum antibiotic therapy required to cover Neisseria gonorrhoea, chlamydia trachomatis, anaerobes, gram-ve facultative bacteria and streptococci

Question 4

What is outpatient treatment for PID?

Answer 4

1st line treatment
IM ceftriaone 500mg + oral doxycyline 100mg twice daily and oral metronidazole 400mg twice a day for 14 days

2nd line treatment
Oral levofloxacin 500mg once a day + oral metronidazole 400mg twice a day for 14 days
Oral ofloxacin 400mg twice a day + oral metronidazole 400mg twice a day for 14 days

Question 5

Who is indicated for inpatient treatment for PID?

Answer 5

• Surgical emergency cannot be excuded
• Clinically severe disease
• Tuboovarian abscess
• PID in pregnancy
• Lack of response to oral therapy
• Intolerance to oral therapy

Question 6

What is the inpatient regimen for PID??

Answer 6

IV ceftriaxone (rocephin) 2g daily + oral doxycycline 100mcg q12h followed by oral doxycycline 100mg bd and oral metronidazole 400mg bd for a total of 14 days

IV clindamycin 900mg 3 times a day + IV gentamicin 2mg/kg loading dose followed by 1.5mg/kg 3 times a day

Patient should demonstrate substantial clinical improvement within 3 after days of initaiton of therapy (reduction in direct/rebound abd tenderness, reduction in uterine, adnexal, cervical motion tenderness). Patients who do not improve within this period require hospitalization, additional diagnostic tests or surgical intervention.