STI-related Lower Abdominal Pain in Women
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Cause
- Neisseria gonorrhoea
- Chlamydia trachomatis
- Anaerobic bacteria (often relating to recurrent infections)
Symptoms
- Lower abdominal pain
- Pain with sexual intercourse (dyspareunia)
- Vaginal discharge
- Dysuria or urethral discomfort
- Fever
Signs
- Lower abdominal tenderness
- Vaginal discharge
- Tenderness on moving the cervix (cervical excitation) on bimanual vaginal examination
- Adnexal tenderness
- Adnexal masses
Investigations
- High vaginal swab culture and sensitivity
- Pelvic ultrasound
TreatmentTreatment Objectives
- To treat for gonorrhoea, chlamydia and anaerobic bacterial infection
- To relieve pain and inflammation
Non-pharmacological treatment
- Remove IUD, if present, 3 days after initiation of drug therapy
Pharmacological Treatment
Evidence Rating: [C]
Out-Patients
- Cefixime, oral, 400 mg stat.
Or
- Ciprofloxacin, oral, 500 mg 12 hourly for 3 days
And
- Doxycycline, oral, 100 mg 12 hourly for 14 days
And
- Metronidazole, oral, 400 mg 12 hourly for 14 days
In-Patients
- Ceftriaxone, IM, 250 mg daily for 3 days
And
- Doxycycline, oral, 100 mg 12 hourly for 17 days
And
- Metronidazole, oral, 400 mg 12 hourly for 17 days