Pelvic inflammatory disease

Background

• Commonly begins as cervical infection (cervicitis) with gonorrhea or chlamydia

Diagnosis

1. Pelvic pain (90%)
2. Constitutional sx-Vaginal discharge (75%)
3. Abnl pelvic exam (60%)
4. Vaginal bleeding (40%)

CDC Treatment Criteria

1. Cervical motion tenderness (CMT) OR
2. Uterine tenderness OR
3. Adnexal tenderness
4. Additional criteria that make the dx more likely:
   1. Fever
   2. WBC >10k
   3. Mucopurulent cervical or vaginal discharge
   4. WBCs on wet mount
   5. Proven infection w/ GC or chlamydia

^CDC Criteria are Sn, but not Sp (i.e. many intra-abominal processes have CMT)

Work-Up

1. Upreg (negative)
2. Pelvic exam (send GC/Chlamy, wet mount)
3. Pelvic US if toxic (r/o TOA)
4. R/O other intra-abd pathology (consider CT, UA, labs)

Treatment

• Tx all partners that had sex w/ pt during previous 60d prior to onset of symptoms

Outpatient

1. CTX 250mg IM x1 + doxycycline 100mg PO BID x14d +/- metronidazole 500mg PO BID x14d
   1. Metronidazole based upon assessment of risk for anaerobes; consider in:
      1. Pelvic abscess
      2. Proven or suspected infection w/ trichomonas or bacterial vaginosis
      3. History of gynecological instrumentation in the preceding 2-3wks

Inpatient

1. (Cefotetan 2gm IV q12h OR cefoxitin 2mg IV q6h) + doxycycline 100mg IV/PO q12h OR
2. Clindamycin 900mg IV q8h + genamicin 2mg/kg QD OR
3. Ampicillin/sulbactam 3gm IV q6hr + doxycycline 100mg IV/PO q12hr

Disposition

Admit for:

1. TOA, Fitz-Hugh-Curtis
2. Sepsis/peritonitis
3. Unable to tol POs
4. Failed outpt Rx

Complications

1. TOA/sepsis
2. Infertility
3. Ectopic
4. Chronic pelvic pain

See Also

Sexually Transmitted Diseases (STD)

Source

CDC 2010, KajiQuestions