Lower Abdominal Pain Syndrome or Pelvic Inflammatory Disease (PID)

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PID is defined as the inflammation of the uterus, fallopian tubes, ovaries and pelvic peritoneum. It is  also  known  as  lower  abdominal  pain  syndrome.  It  commonly  occurs  as  a  result  of  infection  ascending from the cervix. It can also occur as a result of trans-cervical procedure. 

Causes 

  • Neisseria gonorrhoeae
  • Chlamydia trachomatis
  • Anaerobic bacteria 

Clinical Presentation 

  • Lower abdominal pain and tenderness
  • Painful micturition
  • Painful coitus  
  • Abnormal vaginal discharge
  • Menometrorrhagia 
  • Fever and sometimes  
  • Nausea and vomiting

Note:  Delayed or inadequately treated PID may lead to

  •  chronic lower abdominal pain 
  • Pelvic abscess
  • Ectopic pregnancy
  • Dysmenorrhea and infertility 

Investigation(s) if the HF has a laboratory capable of doing: 

  • Wet preparation 
  • Gram stain 
  • Culture and Sensitivity 
  • Fluorescent Microscopy
  • Pap test (Papanicolaou's test) 

Management and Treatment of PID (see flow chart 12.3) 

In-patient treatment of PID 

All patients with PID who have fever or body temperature ≥ 38oC should be admitted for closer care.  The recommended in-patient treatment options for PID are as follows: 

Regimen 1: 

A: cefixime (PO) 400mg 12hourly for 7-14days 

AND 

A: doxycycline (PO) 100mg 12hourly for 7-14days 

AND 

A: metronidazole (PO) 400mg 8-12hourly for 7-14days 

OR 

B: metronidazole (IV) 500mg 8-12hourly for 7-14days 

Regimen 2: 

A: ceftriaxone (IM) 1gm 24hourly for 5-7days 

AND 

A: doxycycline (PO) 100mg 12hourly for 7-14days 

AND 

A: metronidazole (PO) 400mg 8-12hourly 7-14days 

OR 

A: metronidazole (IV) 500mg 8-12hourly 7-14days 

Regimen 3:  

S: clindamycin (IV) 900mg 8hourly for 7-14days 

AND 

A: gentamicin (IV) 1.5 mg/kg 6-8hourly 7-14days 

Note:  For all three regimens, therapy should be continued for two days after the patient has improved  and then be followed by doxycycline (PO) 100 mg 12hourly for 14days

  • Patients taking metronidazole should be cautioned to avoid alcohol. 
  • Doxycycline is contraindicated in pregnancy.