Pelvic inflammatory disease

Background

Commonly begins as cervical infection (cervicitis) with gonorrhea or chlamydia

Diagnosis

1. Pelvic pain (90%)
2. Constitutional sx-Vaginal discharge (75%)
3. Abnl pelvic exam (60%)
4. Vaginal bleeding (40%)

CDC Criteria^^

1. Cervical motion tenderness (CMT)
2. OR, B. Pelvic/adenexal TTP (in pt with no other identifiable cause)

Additional Criteria

1. Fever
2. WBC >10k
3. Abnl cervical discharge (50%)
4. WBC on wet mounte) GC/Chlamy

^^CDC Criteria are sensitive, but not specific (i.e. many intr-abominal processes have CMT)

Work-Up

1. Upreg (negative)
2. Pelvic exam (send GC/Chlamy, wet mount)
3. Pelvic US if toxic (r/o TOA)
4. R/O other intra-abd pathology (consider CT, UA, labs)

Treatment

Outpatient

1. CTX 250mg IM x1 + doxycycline 100mg PO BID x14d +/- metronidazole 500mg PO BID x14d
   1. Metronidazole based upon assessment of risk for anaerobes; consider in:
      1. Pelvic abscess
      2. Proven or suspected infection w/ trichomonas or bacterial vaginosis
      3. History of gynecological instrumentation in the preceding 2-3wks

Inpatient

1) Cefotetan (2gm IV q12h) OR (cefoxitin 2mg IV q6h)

+ doxy (100mg IV/PO q12hOR2)

OR

2) Clinda (900mg IV q8h)

+ gentamycin 3-5 mg/kg QD

+ (after) doxy 100mg PO BID x 14dy

^Rising levels of fluoroquinolone resistance, use them only where prevalence of resistant GC <5%.

^^Treat all partners that had sexual contact with the patient during the previous 60 days prior to the patient's onset of symptoms (advise to avoid sex until treated)

Disposition

Admit for:

1. TOA, Fitz-Hugh-Curtis
2. Sepsis/peritonitis
3. Unable to tol POs
4. Failed outpt Rx

Complications

1. TOA/sepsis
2. Infertility
3. Ectopic
4. Chronic pelvic pain

See Also

Sexually Transmitted Diseases (STD)

Source

CDC 2010, KajiQuestions