Pelvic Inflammatory Infection (PID)
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PID is an inflammation of the uterus, fallopian tubes, ovaries and pelvic peritoneum. It is also known as lower abdominal pain syndrome.
Causes
- Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria
Signs and symptoms
- Abnormal vaginal discharge
- Menometrorrhagia (prolonged and excessive uterine bleeding)
- Lower abdominal pain and tenderness
- Vomiting, painful micturition
- Painful coitus (dyspareunia)
- Fever
Complications
- Chronic lower abdominal pain
- Pelvic abscess
- Ectopic pregnancy
- Dysmenorrhea
- Infertility
Evaluation/Investigations
- Physical examination
- HIV test
- Wet prep
- Endometrial biopsy with histopathologic evidence of endometritis
- Laparoscopic findings consistent with PID
Treatment objectives
- Relieve pain
- Eliminate the causative organism
- Prevent complications
Non-pharmacological treatment
- Advise patient to maintain good hygiene
Pharmacological treatment
First line
Ceftriaxone IM
250 mg as a single dose
AND
Doxycycline
100mg every 12 hours for 14 days
Note: Contraindicated in pregnancy
AND
Metronidazole oral
400-500 mg every 8 hours for 14 days
Second line
Ceftriaxone IM
1g as a single dose
AND
Doxycycline oral
1OO mg, every 12 hours for 14 days
AND
Metronidazole oral
400-500 mg every 12 hours for 14 days
Third line
Gentamicin IV or IM
2 mg/kg loading dose, followed by a maintenance dose of 1.5 mg/kg every 8 hours
Prevention
- Advise to abstain from sexual intercourse until therapy is completed
- Treat partner(s)
- Consistent and correct condom use
Referral
- If no improvement with the above treatment refer for specialist care