Recommendations and Rationale for the Treatment of Pelvic Inflammatory Disease

Oluwatosin Jaiyeoba; Gweneth Lazenby; David E Soper

Disclosures

Expert Rev Anti Infect Ther. 2011;9(1):61-70. 

In This Article

Abstract and Introduction

Abstract

Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo–ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.

Introduction

Pelvic inflammatory disease (PID) presents as a spectrum of infection-induced inflammation of the upper genital tract that includes endometritis, salpingitis, pelvic peritonitis and/or tubo–ovarian abscess (TOA).[1] Acute PID is caused by the ascending spread of microorganisms from the vagina and/or endocervix to the endometrium, fallopian tubes and/or adjacent structures.

Over 800,000 cases of PID are diagnosed annually in the USA and estimates indicate that the direct costs of treatment exceed US$2 billion.[2] This estimate fails to take into consideration both the recent increase in Chlamydia trachomatis and gonococcal infections[3] and the existence of subclinical or atypical PID (also referred to as 'silent salpingitis'), which may go untreated.[4]

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