Pelvic Inflammatory Disease (aka PID aka salpingitis)

Pelvic Inflammatory Disease  (PID aka salpingitis)

  • Infection of the uterus, fallopian tubes & adjacent structures
  • Incidence is 1 million cases/year
  • Causes:  neisseria gonorrhea, chlamydia trachomatis (main), anaerobic bacteria
  • Risk factors:  young age, multiple sex partners, intrauterine contraceptive devices (diaphragm), past history of gonorrhea or chlamydia
  • Symptoms:  nonradiating lower abdominal pain, fever/chills, cervical motion tenderness, N/V, vaginal discharge, dyspareunia (painful sex)
  • Complications:  infertility, ectopic pregnancy, chronic pelvic pain
  • Diagnosis:   based on the clinical triad (symptoms, adnexal tenderness, pain w/ cervical manipulation), laparoscopic visualization of the pelvis, will have an abnormal mucociliary wave pattern of the fallopian tube endothelial cells
  • Outpatient Treatment:
    • ceftriaxone 250 mg IM once + doxycyline 100 mg PO BID x 14 days
      • May add Metronidazole 500 mg BID x 14 days if trichomyosis is suspected
    • Alternative trxt:  cefoxitin 2 g IM once + probenicid 1 g PO once + doxycycline 100 mg PO BID x 14 days
      • May add Metronidazole 500 mg BID x 14 days if trichomyosis is suspected
  • Inpatient treatment:
    • Cefoxitin 2 g IV q 6 h + doxycycline 100mg IV q 12 h
      • Do this for 24 h after improvement then do doxycycline 100 mg PO BID x 14 days
    • Alternatives trxt:  clindamycin 900 mg IV q 8 h + gentamicin LD 2 mg/kg then 7 mg/kg/day
      • Do this for 48 h after improvement then do doxycycline 100 mg PO BID x 14 days
    • Should also add IV fluids + analgesics for the 1st 24 hours (morphine, codeine)

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