What is Pelvic Inflammatory Disease (PID)?

From the Guidelines

Pelvic Inflammatory Disease (PID) should be treated promptly with a broad-spectrum antibiotic regimen to prevent long-term complications and improve quality of life. The treatment approach should prioritize covering the common causative organisms, including Chlamydia trachomatis and Neisseria gonorrhoeae, as well as other potential bacterial pathogens 1.

Key Considerations

• The clinical syndrome of PID encompasses a wide range of pathologic processes and etiologic agents, resulting in a broad clinical spectrum that includes acute, silent, atypical, and chronic forms of the disease 1.
• The site(s) of disease and the etiologic agent(s) involved can vary, making it essential to tailor the treatment approach to the individual case.
• Treatment regimens should be guided by the most recent and highest-quality evidence, with a focus on preventing morbidity, mortality, and improving quality of life.

Treatment Approach

• A combination of antibiotics, such as ceftriaxone and doxycycline, is recommended to cover the common causative organisms, with optional metronidazole for anaerobic coverage.
• Patients should be closely monitored for improvement, with follow-up within 72 hours for outpatient treatment, and hospitalization considered for severe cases or treatment failure.
• Sexual partners from the past 60 days should be evaluated and treated for STIs to prevent reinfection and transmission.
• Patients should abstain from sexual intercourse until treatment completion and resolution of symptoms to prevent complications and promote recovery.

Supportive Measures

• Pain medication and rest are essential supportive measures during recovery to manage symptoms and promote healing.
• Prompt treatment and supportive care can help prevent long-term complications, such as chronic pelvic pain, ectopic pregnancy, and infertility, and improve overall quality of life.

From the Research

Definition and Causes of PID

• Pelvic inflammatory disease (PID) is an infection of the upper genital tract occurring predominantly in sexually active young women 2
• Common causes of PID include Chlamydia trachomatis and Neisseria gonorrhoeae, but other pathogens such as Mycobacterium tuberculosis may also be involved 2

Diagnosis and Treatment of PID

• The diagnosis of PID is made primarily on clinical suspicion, and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections who have unexplained lower abdominal or pelvic pain and cervical motion, uterine, or adnexal tenderness on examination 2
• Mild to moderate disease can be treated in an outpatient setting with a single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days 2
• Hospitalization for parenteral antibiotics is recommended in patients who are pregnant or severely ill, in whom outpatient treatment has failed, those with tubo-ovarian abscess, or if surgical emergencies cannot be excluded 2

Antibiotic Regimens for PID

• The optimal treatment regimen for PID is broad-spectrum antibiotics administered intravenously, intramuscularly, or orally 3
• Regimens containing azithromycin versus regimens containing doxycycline may have little to no difference in rates of cure for mild-moderate PID, but azithromycin may improve rates of cure in mild-moderate PID compared to doxycycline in some studies 3
• Regimens containing quinolone versus regimens containing cephalosporin may have little to no difference in rates of cure for mild-moderate PID or severe PID 3
• The addition of metronidazole to ceftriaxone and doxycycline may be beneficial in reducing endometrial anaerobes, decreasing M. genitalium, and reducing pelvic tenderness compared to ceftriaxone and doxycycline alone 4

Outpatient Treatment of PID

• Outpatient treatment of PID with cefoxitin and doxycycline has been shown to be effective in clinically curing or improving patients with probable PID 5
• A combination of cefoxitin and doxycycline may be effective for ambulatory treatment of PID, with high rates of clinical cure or improvement and negative cultures for Chlamydia trachomatis and/or Neisseria gonorrhoeae after therapy 5