STI-related Lower Abdominal Pain in Women

exp date isn't null, but text field is

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