Pelvic Inflammatory Disease

Difintion – the infection of female internal genitalia beyond the interinal os of cervix

Pelvic inflammatory disease (PID) Continues to be a problem among women of reproductive age group and is one of the most common serious complications of sexually transmitted diseases.

More important than the infection itself is that the women develop PID suffers serious long-term health problems as a result of it.

These includes infertility, entopic pregnancy, tuboovarian abscess, pyosalpinx, chronic pelvic pain and pelvic adhesive disease

Predisposing factors

Previous PID, Multiple sexual partners, Adolescent (sexuall active) and the use of intrauterine contraceptive divice

Etiology

· Neisseria gonorrhoeae

· Chlamydia trachomatis

· Mycoplasma hominis

· Facultative and anaerobic bacteria

Diagnosis

· history of the patient

· Physical examination

· Cludocentesis

· Laparoscopy

· White blood cell count

Criteria for diagnosis: 3 major or 2 major plus 1 minor

Treatment

The patient could be treated at out patient department or as inpatient in wards depending on the severity of the disease.

Out patient treatment

First drug of choice

Combination of antibiotics

· Metrendazol

· Tetracycline or doxycyclin

· Penicillin

Second drug choice

· Cefoxitin 2 gm in plus progenies 1 g orally concurrently or

· Coftriaxone 200 ng in or other third – generation cephalosporin (eg. Cettizoxime or cefotaxime) plus

· Doxycycline 100ng po BID for 14 days

Inpatient treatment

First drug of choice

· Cefoxitin 2 gm iv every 6 hours or

· Cefotetan 2 gm iv every 12 hours plus

· Doxycycline 100ng po or iv every 12 hours

Second drug of choice

· Clindamycin 900 mg iv every 8 hours plus

· Gentamycin iv or in loading dose (2 mg/ kg of body weight) followed by a maintenance dose (1.5mg/kg) every 8 hours.

The above regimens are given for at least 48 hours after the patient demonstrates significant clinical improvement, then doxycycline 100mg po BID (if treated with regimen B) for 14 days in both cases.

If there is IUCD, remove it.

Partener treatment

To minimize infection, it is recommended that all parteners of women with gonococcal or chlamydial PID be cultured and treated with a combination of agents effective against both.

Complications

· Tubo ovarian abscesses

· Infertility

· Ectopic pregnancy etc.