Basics of PID

Mon, 12/13/2021 - 5:00am
Author: 
Sarah Perelman M.D.
Editor: 
Alison Jaworski, MD

Pelvic Inflammatory Disease Review 

Dr. Sarah Perelman   

 

Organisms: gonorrhea, chlamydia, HSV, trichomonas, BV (gardnerella vaginalis), mycoplasma, or other aerobic and anaerobic bacteria 

  • If chronic and in endemic area, consider TB  

  • If IUD in place, consider actinomyces  

 

Risk factors: low SES, unprotected sex, IUD inserted in last month 

 

Diagnosis: CLINICAL! Cervical motion tenderness + adnexal/lower abdomen tender/crampy. 

  • Usually there is vaginal discharge 

  • RUQ pain/jaundice accompanied by lower pelvic pain (Fitz-High-Curtis) 

  • Fever or high ESR/CRP + pelvic pain and unidentified source of infection 

 

Lab: leukocytes on wet mount 

 

Imaging:  

  • US: thickened fallopian tubes, pelvic fluid, and/or tubo-ovarian abscess 

  • CT: inflamed pelvic organs (if R fallopian tube is swollen can be due to appendicitis, while left fallopian tube swelling is specific for PID) 

 

Treatment 

  • Antibiotics: 

  • If admitting: IV Cefotetan 2g q12 + doxycycline 100mg q12  (*or ceftriaxone IV + doxy + flagyl)

  • If discharging: ceftriaxone 250mg IM once + doxycycline 100 mg BID x14 days  

  • Test for and co-treat BV with metronidazole if there are clue cells on wet mount 

  • Tubo-ovarian abscess: usually responds to antibiotics, same treatment as above. Only consult for surgical drainage if no improvement in 72h of treatment or >9cm 

Disposition: admit if pregnant, appears toxic, tubo-ovarian abscess, poor compliance, failed outpatient regimen 

 

Discharge Instructions: no sex until 1 week after treatment completed, notify all partners within prior 60 days

 

References: 

Weiss, B., Shepherd SM. Pelvic Inflammatory Disease In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill; 2020:(Ch) 103.