PID

Question 1

Risk factors

Answer 1

Age under 30 years
Partner with a sexually transmitted infection (STI)
Recent change in sexual partner
Recent STI
Recent pregnancy
Upper genital tract instrumentation
IUD insertion

Question 2

PID management

Answer 2

Advise to abstain from sex or use condoms for 2 weeks from the start of treatment, and until partner(s) tested and treated
Rest and simple analgesia where required (non-steroidal anti-inflammatory medications, paracetamol)
Consider removal of IUD if no response to treatment in 48-72 hours

Question 3

Partner notification

Answer 3

Contact tracing is important to prevent re-infection and reduce transmission
All sexual contacts in the last 3 months should be notified
written information can be helpful
Notifying all contacts may not be possible e.g. if there is insufficient information or a threat of violence
Contacts should have a sexual health check, and empirical treatment with doxycycline 100 mg orally twice daily for 7 days,
Advise contacts to abstain from sex or use condoms until results are available, and treatment completed
Patient-delivered partner therapy is not legal in Aotearoa New Zealand

Question 4

Investigations

Answer 4

A vulvovaginal NAAT swab for chlamydia & gonorrhoea testing prior to speculum insertion.
Insert speculum, examine vagina and cervix.
Endocervical culture swab for gonorrhoea (if gonorrhoea culture available).
High vaginal culture swab for candida & BV & trichomoniasis (if NAAT for trichomoniasis not available).
Additional anorectal NAAT swab for chlamydia & gonorrhoea testing as indicated based on sexual history.
Bimanual examination for pelvic masses or tenderness.
Urine pregnancy test and urinalysis dipstick.
Universal serology for HIV and syphilis.
Targeted hepatitis B and C serology if hepatitis B status unknown and risk factors present.
Consider FBC and CRP in severe cases or diagnostic uncertainty.
Vital signs: Temperature, pulse, blood pressure.

Question 5

PID Discharge advice

Answer 5

Advise to abstain from sex until abdominal pain has settled and to use condoms for 14 days from the start of treatment and until 1 week after
all sexual contacts have been treated.
Repeat sexual health check 3 months post treatment