Pelvic Inflammatory Disease

Pelvic Inflammatory Disease, or PID, is a condition where there is inflammation by infection in the upper genital tract. It is not associated with pregnancy or intraperitoneal pelvic operations. It may include the infection of the edometrium, myometrium, serosa, the tubes, and the ovaries, broad ligaments (parametritis). Infection of the tubes is the most common ones. The disease results from ascending infection from the bacterial flora of the vagina and cervix. Less commonly spread by tranperitoneal hematogenous.

• Annually acute PID occurs in 1-2 % of all young sexually active women
• Most common in women ages 16-25
• 1 in 4 women with acute PID experience medical sequelae.
• The rate of ectopic pregnancy increases 6 to 10 fold and the chance of developing chronic PID increases 4 fold.
• The incidence of infertility varies from 6-60% depending on the severity of the infection and the number of episodes of infection and age of the patient.
• After one episode, incidence of infertility is increased 11.4%. After two episodes, 23.1%, and after three episodes 54.3%
• Women with one episode of PID are more prone to developing a second episode.
• Sequelae of PID – adhesions, hydrosalpinx.

Etiology of Pelvic Inflammatory Disease (PID)

• Polymicrobial infection.
• Mixture of aerobic and anaerobic organisms.
• The majority of cases are caused by GC and CT. These two organisms coexist in the same person 25-50% of the time.
• Normal vaginal flora are also seen in the tubes in 50% of the cases.

Signs and Symptoms of Pelvic Inflammatory Disease (PID)

• Vary considerably
• Non specific
• Silent or asymptomatic
• 90% with lower abdominal pain.
• 75 % with mucopurulent discharge
• 75% have ESR more than 15
• 50% have capitalize WBC’s over 10 thousand

Diagnosis of Pelvic Inflammatory Disease

1. History of lower abdominal pain and tenderness with or without evidence of rebound.
2. CMT
3. Adnexal tenderness (may be bilateral or unilateral)

Additional Criteria:

• Oral temperature of 101
• Abnormal cervical or vaginal discharge
• Elevated C reactive protein
• Lab documentation of cervical infection with GC or CT

Treatment

Outpatient

• Regimen A
  ofloxacin 400mg PO bid for 14 days
  plus
  metronidazole 500mg PO bid for 14 days
• Regimen B
  cefoxitin 2g IM
  plus
  probenecid 1g orally single dose

OR

• Ceftrioxin 250mg IM or other perenteral third generation cephalosporins – example cefotaxime
  plus
  Doxicycline 100mg PO bid for 14 days
  

Inpatient

• Regimen A*
  Cefoxitin 2g IV q6h, or
  Cefotetan 2g IV q12h
  Plus
  Doxycycline, 100mg PO or IV q12h

*note: the above regimen should be continued for at least 48 hours after the patient shows significant clinical improvement. After hospital discharge, doxycycline 100mg PO bid should be continued for a total of 14 days

• Regimen B*
  Clindamycin, 900mgIVq8h.
  plus
  Gentamicin, loading dose IV or IM (2 mg/kg) followed by 1.5 mg/kg IV or IM q8h

*note: the above regimen should be continued