Pelvic Inflammatory Disease (PID)

INTRODUCTION

PID is a syndrome of inflammatory disorders of the female upper genital tract, including endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis. PID is most commonly sexually acquired, although may result from gynaecological procedures such as IUD insertion. No pathogen is identified in most cases.

Serious consequences include tubal factor infertility (20%), chronic pain (20%) and ectopic pregnancy (10%).

Acute PID

• Fever ≥38°C

• Moderate-to-severe lower abdominal pain

Chronic PID

• Ache in the lower back

• Mild lower abdominal pain

Both acute and chronic

• Dyspareunia

• Menstrual problems (e.g. painful, heavy or irregular periods)

• Intermenstrual bleeding

• Abnormal, perhaps offensive, purulent vaginal discharge

• Painful or frequent urination

INVESTIGATIONS

Diagnosis is clinical based on symptoms and examination. The most common signs are adnexal tenderness and cervical motion tenderness.

• Endocervical swabs for NAAT N. gonorrhoeae, C. trachomatis and M. genitalium

• Endocervical swab for culture

• Blood culture if febrile

• Pelvic ultrasound to detect alternative causes of pain

TREATMENT OF PID (SEXUALLY ACQUIRED)

Note: Any IUCD should be removed if there is no response to treatment in 48 to 72 hours. Current sexual partners should be treated with agents effective against C. trachomatis (and N. gonorrhoeae if likely), irrespective of test results.

Mild to moderate infection (treated as an outpatient)

• Doxycycline 100 mg (o) bd for 14 d plus

• Ceftriaxone 500 mg IM as a single dose (for gonorrhoea) plus

• Metronidazole 400 mg (o) bd for 14 d

If M. genitalium confirmed, use moxifloxacin 400 mg daily for 14 d.

If pregnant or breastfeeding, use azithromycin 1 mg stat (rpt 1 wk) instead of doxycycline.

NON-SEXUALLY ACQUIRED PID

Amoxicillin/clavulanate 875 mg (o) bd for 14 d for mild-to-moderate infection. Consider IV therapy if no response within 72 hrs.