Pelvic Inflammatory Disease

Pelvic Inflammatory Disease is an infection and inflammation of the upper genital tract
in women, typically involving the uterus, ovaries and fallopian tubes.
The infection usually ascends from the vagina and spreads to the upper genital tract
leading to salpingitis, endometritis, pelvic peritonitis and formation of tubal ovarian
abscess.
Causes
85% Cases
 Chlamydia trachomatis.
 Neisseria gonorrhea.
15% Cases
 Mycoplasma genitalium.
 Bacteroides fragilis.
 Peptostreptococcus anaerobius.
Risk factors
 History of abortion.
 Intrauterine device implants.
 Multiple sexual partners.
 Previous history of Pelvic Inflammatory Disease.
 Previous Sexually transmitted disease.
 Untreated sexually transmitted disease
Pathophysiology
 Infection of the upper female genital tract leads to inflammatory damage,
resulting in scarring, adhesions, and partial or total obstruction of the Fallopian
tubes.
 This can result in loss of the ciliated epithelial cells along the fallopian tube lining,
resulting in impaired ovum transport and increased risk for infertility and ectopic
pregnancy. Additionally, adhesions can lead to chronic pelvic pain.
Signs and Symptoms
  Abnormal vaginal bleeding.
 Lower abdominal pain.
 Painful sexual intercourse.
 Vaginal discharge.
Complications
 Chronic Pelvic Pain.
 Ectopic Pregnancy.
 Infertility.
 Ovarian and pelvic abscess
Treatment
First Line
 I.M Ceftriaxone 500 mg single dose.
 Plus, Oral Doxycycline 100 mg twice daily for 14 days.
 Plus, Oral Metronidazole 400 mg twice daily for 14 days
OR
 Oral Cefixime 400 mg single dose.
 Plus, Oral Doxycycline 100 mg twice daily for 14 days
 Plus, Oral Metronidazole 400 mg twice daily for 14 days
OR
 IM Cefoxitin 2g single dose with Oral Probenecid 1g Single dose.
 Plus, Oral Doxycycline 100 mg twice daily for 14 days.
 Plus, Oral Metronidazole 400 mg twice daily for 14 days.
Second Line
 IV Clindamycin 900mg every 8 hours.
 Plus, IV/IM Gentamycin 2mg/kg every 8 hours.
OR
 IV Ampicillin/Sulbactam 3g every 6 hours.
 Plus, Oral doxycycline 100mg twice daily

OR
  IV Cefotetan 2g every 12 hours.
 Plus, Oral doxycycline 100mg twice daily
Patient Education
 All women with PID should test for HIV.
 Abstain from sex during course of treatment.
 Treat your partner as well.
 Do not take alcohol when taking metronidazole.
 Avoid sex during menstruation.
 Finish the dose even when signs and symptoms resolve.