Infectious Disease Compendium

Pelvic Inflammatory Disease

Diagnosis

1) uterine or adnexal tenderness or 2) cervical motion tenderness and the 2002 Guidelines recommend that a PID diagnosis be considered for women with any pelvic tenderness and any signs of lower genital tract inflammation.

Additional diagnostic criteria to enhance the specificity include oral temperature greater than 101°F (38.3°C); abnormal cervical or vaginal mucopurulent discharge; white blood cells on saline microscopy of vaginal secretions; elevated erythrocyte sedimentation rate; elevated C-reactive protein; and laboratory documentation of cervical infection with N. gonorrhea or C. trachomatis.

Epidemiologic Risks

Sexually transmitted disease.

If with an IUD, remove if less than three weeks after placement.

Microbiology

N. gonorrhoeae, C. trachomatis, anaerobes, Gram-negative bacteria (E. coli), and streptococci.

Mycoplasm genitalium can cause a milder form of PID with less elevation in inflammatory markers like ESR (PubMed).

Empiric Therapy

from the CDC Guidelines/NEJM 2015 review:

Outpatient regimen for mild-to-moderate pelvic inflammatory disease

Doxycycline 100 mg po bid x 14d with or without metronidazole 500 mg bid x 1 d, PLUS one of the following:

Ceftriaxone 250 mg im single dose

Cefoxitin 2 g im with probenicid 1 g po

Other iv third-generation cephalosporin: cefotaxime or ceftizoxime

Inpatient regimen for moderate-to-severe pelvic inflammatory disease with or without tubo-ovarian abscess

One of the following:

Cefotetan 2 g iv q 12 hr plus doxycycline 100 mg po or iv q 12 hr

Cefoxitin 2 g iv q 6 hr plus doxycycline 100 mg po or iv q 12 hr

Clindamycin 900 mg iv q 8 hr plus gentamicin 3 to 5 mg/kg iv qd

Pearls

Don'’t be creative. Follow the CDC guidelines

Rants