Pelvic inflammatory disease
Background
-Commonly begins as cervical infection (cervicitis) with gonorrhea or chlamydia
Diagnosis
-Pelvic pain (90%)-Constitutional sx-Vaginal discharge (75%)-Abnl pelvic exam (60%)-Vaginal bleeding (40%) CDC Criteria**A. Cervical motion tenderness (CMT)ORB. Pelvic/adenexal TTP (in pt with no other identifiable cause) Additional Criteriaa) Feverb) WBC >10kc) Abnl cervical discharge (50%)d) WBC on wet mounte) GC/Chlamy **CDC Criteria are sensitive, but not specific (i.e. many intrabdl 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==
Outpatient: 1) Ceftriaxone (250 mg IM x 1)
+ doxycycline (100mg PO BID x 14 days)
+/- metronidazole (500mg PO BID x 14 days)
OR
2) Cefoxitin (2g IM x 1)
+ probebenecid (1gm PO x 1)
+ doxycycline (100mg PO BID x 14 days)
+/- metronidazole (500mg PO BID x 14 days)
OR
3) 3-gen cephalosporin [cefotaxime (1gm IM x1) OR ceftizoxime (1gm IM x 1)
+ doxycycline (100mg PO BID x 14 days)
+/- metronidazole (500mg PO BID x 14 days) *Metronidazole based upon assessment of risk for anaerobs. Consider in:
a) Pelvic abscess
b) Proven or suspected infection Trichomonas vaginalis or bacterial vaginosis
c) History of gynecological instrumentation in the preceding two to three weeks. Inpatient:1) Cefotetan 2gm IV q12h OR cefoxitin 2mg IV q6h + doxy 100mg IV/PO q12hOR2) Clinda 900mg IV q8h + 4.5 mg/kg QD + (after) doxy 100mg PO BID x 14dy
- Rising levels of fluoroquinolone resistance, use them only where prevalence of resistant GC <5%.
*Treat all partners that had sexual contact with the patient during the previous 60 days prior to the patient's onset of symptoms (advise to avoid sex until treated). ==Disposition==
Admit for:
1) TOA, Fitz-Hugh-Curtis
2) Sepsis/peritonitis
3) Unable to tol POs
4) Failed outpt Rx
Complications
-TOA/sepsis
-Infertility
-Ectopic
-Chronic pelvic pain
Source
CDC, KajiQuestions