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CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines PID comprises a spectrum of inflammatory disorders of the upper female genital tract. Sexually transmitted organisms, especially N. Gonorrhoeae and C. Trachomatis, are implicated in many cases of PID. Cytomegalovirus (CMV), M. Hominis, U. Urealyticum, and M. Genitalium might be associated with some cases
CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines PID comprises a spectrum of inflammatory disorders of the upper female genital tract. Sexually transmitted organisms, especially N. Gonorrhoeae and C. Trachomatis, are implicated in many cases of PID. Cytomegalovirus (CMV), M. Hominis, U. Urealyticum, and M. Genitalium might be associated with some cases
CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines PID comprises a spectrum of inflammatory disorders of the upper female genital tract. Sexually transmitted organisms, especially N. Gonorrhoeae and C. Trachomatis, are implicated in many cases of PID. Cytomegalovirus (CMV), M. Hominis, U. Urealyticum, and M. Genitalium might be associated with some cases
gonorrhoeae and C. trachomatis, are implicated in many cases
However, microorganisms that comprise the
vaginal flora (e.g., anaerobes, G. vaginalis, Haemophilus influenzae, enteric Gramnegative rods, and Streptococcus agalactiae) also have been associated with PID
contributes to inflammatory sequelae in the upper reproductive tract
Laparoscopy can be used to obtain a more
accurate diagnosis of salpingitis and a more complete bacteriologic diagnosis.
However, this diagnostic tool frequently is not
readily available, and its use is not easy to justify when symptoms are mild or vague.
Moreover, laparoscopy will not detect endometritis
and might not detect subtle inflammation of the fallopian tubes
Diagnosis of PID is usually based on clinical
findings
Because of the difficulty of diagnosis and the
potential for damage to the reproductive health of women (even by apparently mild or subclinical PID), health-care providers should maintain a low threshold for the diagnosis of PID
be present before the initiation of empiric treatment could result in insufficient sensitivity for the diagnosis of PID.
The presence of signs of lower-genitaltract
inflammation (predominance of leukocytes in vaginal secretions, cervical exudates, or cervical friability), in addition to one of the three minimum criteria, increases the specificity of the diagnosis.
One or more of the following additional criteria
can be used to enhance the specificity of the minimum criteria and support a diagnosis of PID
Abnormal cervical or vaginal mucopurulent discharge Presence of abundant numbers of WBC on saline microscopy of vaginal fluid Elevated ESR Elevated C-reactive protein Laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.
Endometrial biopsy with histopathologic evidence
of endometritis
Transvaginal sonography or magnetic resonance
imaging techniques showing thickened, fluid filled tubes with or without free pelvic fluid or tuboovarian complex, or Doppler studies suggesting pelvic infection (e.g., tubal hyperemia)
Laparoscopic abnormalities consistent with PID.
Patients should demonstrate substantial
clinical improvement within 3 days after initiation of therapy.
Patients who do not improve within this period
usually require hospitalization, assessment of the antimicrobial regimen, additional diagnostic tests, and surgical intervention.
during the 60 days preceding the patients onset of symptoms. the patients most recent sex partner, If a patients last sexual intercourse was >60 days before onset of symptoms or diagnosis CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines
Evaluation and treatment are imperative because
of the risk for reinfection of the patient and the strong likelihood of urethral gonococcal or chlamydial infection in the sex partner Male partners of women who have PID caused by C. trachomatisand/orN. gonorrhoeaefrequently are asymptomatic. should be treated empirically with regimens effective against both of these infections, regardless of the etiology of PID or pathogens isolated from the infected woman. CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines
Arrangements should be made to provide
care or appropriate referral for male sex partners of women who have PID. Patients should be instructed to abstain from sexual intercourse until therapy is completed and until they and their sex partners no longer have symptoms CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines
Screening and treating sexually active
women for chlamydia reduces their risk for PID Although BV is associated with PID, whether the incidence of PID can be reduced by identifying and treating women with BV is unclear CDC - Pelvic Inflammatory Disease 2010 STD Treatment Guidelines
Provide sexual health education
Avoid Risks eg. multiple partners, unprotected sex Protections : condom STD Screening including : Syphilis AIDs HepB Prevention of post PID complication eg. ectopic pregnancy, Infertility 3,2551 . .
Because of the high risk for maternal morbidity and
preterm delivery, pregnant women who have suspected PID should be hospitalized and treated with parenteral antibiotics. CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines
PID in pregnancy is associated with an increase in
both maternal and fetal morbidity, therefore parenteral therapy is advised although none of the suggested evidence based regimens are of proven safety in this situation. The risk of giving any of the recommended antibiotic in very early pregnancy (prior to a pregnancy test becoming positive) is justified by the need to provide effective therapy and the low risk to the foetus . UK National Guideline for the Management of Pelvic Inflammatory Disease 2011
The risk for PID associated with IUD use is
primarily confined to the first 3 weeks after insertion and is uncommon thereafter Evidence is insufficient to recommend that the removal of IUDs in women diagnosed with acute PID. However, caution should be exercised if the IUD remains in place, and close clinical followup is mandatory CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines
In the past, Clinicians generally removed IUDs to
optimize the treatment of PID. This was primarily based on concerns that as a foreign body, removal of the IUD enhanced clinical response.
randomized study of 46 women in Sweden, Soderberg,
and Lindgren reported no differences in response to treatment whether the IUD was removed or left in place
randomized trial from Turkey, noted that clinical
improvement (e.g., absence of pelvic pain, vaginal discharge, and pelvic tenderness) was more common in the group whose IUDs were removed.
If the provider elects to leave the IUD in place while PID
is being treated, close clinical follow up is important Infectious Diseases in Obstetrics and Gynecology Volume 2011 Review Article : Treatment of Acute Pelvic InflammatoryDisease Richard L. Sweet Department of Obstetrics and Gynecology, University of California
Differences in the clinical manifestations of PID
between HIV-infected women and HIV-negative women have not been well delineated.
more comprehensive observational and controlled studies
now have demonstrated that HIV-infected women with PID have similar symptoms when compared with uninfected controls : except, they were more likely to have a TOA
both groups of women responded equally well to standard
parenteral and oral antibiotic regimens.
Regardlesss of these data, whether the management of
immunodeficient HIV-infected women with PID requires more aggressive interventions (e.g., hospitalization or parenteral antimicrobial regimens) has not been determined. CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines
microbiologic findings for HIV-positive and HIVnegative women were similar
except HIV-infected women had higher rates of concomitantM. hominis, candida, streptococcal, and HPV infections and HPV-related cytologic abnormalities. CDC - Pelvic Inflammatory Disease - 2010 STD Treatment Guidelines