Pelvic inflammatory disease

Question 1

diagnostic criteria?

Answer 1

At least one:
- uterine, cervical, or adnexal tenderness

Supporting:

• Fever > 38 C
• Mucopurulent discharge
• Positive GC/CT
• Gram positive diplococci on gram stain
• WBC > 10 K
• Elevated CRP, ESR
• WBC on saline wet prep

Question 2

long term sequelae of PID?

Answer 2

• chronic pain
• infertility
• increased risk of ectopic pregnancy

Question 3

what is the most specific finding to support PID diagnosis?

Answer 3

• EMB with endometritis
• TVUS: fluid filled tubes, TOA, or increased dopplers (reflecting hyperemia)
• LSC findings c/w PID

Question 4

what should be collected on all pt’s with suspected PID?

Answer 4

• GC/CT

- HIV

Question 5

what coverage do you need with abx?

Answer 5

• G/C

- anaerobic coverage

Question 6

criteria for inpatient management?

Answer 6

• cannot rule out other surgical emergencies (i.e. appendicitis)
• TOA
• Pregnancy
• Severe illness; n/v or high fever
• Non-response to oral therapy within 72 hours
• Unable to follow-up as outpatient; unable to tolerate PO therapy

Question 7

outpatient regimens for PID

Answer 7

CTX 1 g IM and Doxycycline 100 mg PO BID x 14 days +/- Flagyl 500 mg PO BID x 14 days

Cefoxitin 2 g IM + Probenicid 1 g PO + Doxy 100 mg PO BID x 14 days +/- Flagyl 500 mg BID PO x 14 days

If cephalosporin allergy, low risk of gonorrhea, and follow-up ensured, can do Levofloxacin 500 mg QD< Flagyl 500 mg BID x 14 days

Question 8

inpatient regimen

Answer 8

Cefoxitin 2 g IV q6hr or Cefotetan 2g IV q12 hrs
Doxycycline 100 mg PO or IV q12 hr

alternative:
Clindamycin 900 mg IV q8hours, Gentamicin 2 mg/kg loading dose, then 1.5 mg/kg q8hrs

Question 9

what if G/C positive?

Answer 9

retest in 3 months

Question 10

partner treatment/testing?

Answer 10

• all sexual partners within last 60 days should be treated, and tested for GC
• if last intercourse > 60 d, then last sexual partner

Question 11

IUD management?

Answer 11

• highest risk of getting PID with IUD is first three weeks
• initially try to treat without removing
• if no clinical improvement in 48-72 hrs, would consider removing

Question 12

TOA - when does drainage help?

Answer 12

• 25% are refractory to abx alone
• in study looking at drainage + abx vs abx alone for < 10 cm TOA, drain + abx had significantly shorter hospital stay, less likely to require surgical intervention

Question 13

how quickly can you transition from IV to PO?

Answer 13

if improving within 24-48 hours