Treatment & sequelae of pelvic inflammatory disease - Orion Group

Review ArticleTreatment & sequelae of pelvic inflammatory diseaseNasreen SZAThe ORION Medical Journal 2007 May;27:454IntroductionPelvic inflammatory disease (PID) refers toacute infection of the upper genital tract,involving any or the entire uterus, oviductsand ovaries. Since none of the diagnostic testsis highly specific & sensitive there is nosingle diagnostic gold standard. So clinicianmust have a low threshold for considering thediagnosis and must be prepared to initiateempiric antibiotic therapy as late sequelae ofPID remain common and even moreexpensive. Neverthless any young womanwith low abdominal, adenexal & cervicaltenderness1 with any of high ESR,leucocytosis, raised CRP, endocervical swab+ ve & USG of pelvic collection should beconsidered having PID.Treatment indicated as OPD or as inpatient.Recommendation of hospitalization includes- Having surgical emergencies. Do not respond to outpatient therapy. Pregnant ladies ( Though PID is rare). Who are clinically very ill. Having Pelvic Abscess. Who are immunodeficient.Outpatient therapyOral Levofloxacin (500 mg once daily) orOfloxacin (400 mg twice daily) for 14 days 1 .Parenteral therapy can be used as analternative. Ceftriaxone 250 mg I.M orCefoxitime 2 gm I.M followed by Doxicyclin100 mg twice daily for 14 days. For youngerwoman less than 18 yrs should haveparenteral therapy. Doxicyclin can bereplaced by Azithromycin 1 gm duringparenteral administration of Cephalosporin.Inpatient therapyBroad spectrum Cephalosporin- Cefoxitimeor Ceftriaxone 2 gm I.V 12 hourly withDr. Sk. Zinnat Ara Nasreen, MBBS, FCPS,MRCOG (London), Associate Prof. & Head,Department of Obs & Gynae, ZH Sikder WomensMedical College.The ORION. Vol 27, May 2007Metronidazole (500 mg 8 hourly), on theother hand Clindamycin (900 mg I.V 8 hourly)with Metronidazole or either Ofloxacin orAmoxiclav along with Metronidazole couldbe used initially.Parenteral antibiotics need to be continued for24 hours after a clear clinical response,followed by Azithromycin 1 gm orally orDoxicyclin 100 mg B.D for total 14 days.Every treatment for PID must beaccompanied by an intensive discussion of thepathophysiology of disease & futureprevention & concomitant need for partnertreatment.SequelaeMost of morbidities arise from scarring andadhesion formation that accompany healingof damaged tissue after infection. Theseeffects take at least three forms- infertility,ectopic pregnancy, chronic pelvic pain.Infertility: Women with tubal factorsinfertility occurs due to damage & tearing oftubes by PID, symptomatic or asymptomaticPID produce indistinguishable permanentinjury to the Fallopian Tubes mostparticularly their internal epithelium 2 .Ectopic pregnancy: Approximately 10-13%of conception will be ectopic afterlaparoscopically mild to moderate PID &almost 50% after severe PID 3 . Among womenwith prior ectopic pregnancy & clinical PID,60% of conception were recurrent ectopicpregnancy 4 .Pelvic pain: About b to a of women withsymptomatic PID develop chronic pelvicpain 5 . This syndrome presumably results fromadhere and tethering or fixation of organsintend to enjoy freedom of movement &expansion during physical activity, coitus &ovulation.www.orion-group.net/journalswww.orion-group.net/medicaljournal

Review ArticleSex partners: Male sex partner of womenwith PID should be examined and treated ifthey had coitus with the patient duringprevious 60 days.ConclusionEarly recognition & appropriate treatment ofPID can prevent many of the complicationsparticularly infertility. It is also important toscreen other sexually transmitted diseaseduring treatment of PID.References1. Workwoski, KA, Berman, SM, STDTreatment guideline 2006, MMWR RecomRep 2006;55:1.2. Cates, W, Joesoef, MR, Goldman MB,Atypical PID; can we identify clinicalpredictors? Am J. Obstet Gynaecol1993;169:341.3. Bernstein, R, Kennedy, WR, Waldron, Jacute PID, A clinical follow up, Int. J. Fertil1987;32:229.4. Nagamani, M. London, S. St. Amand. P,Factors Influencing Fertilize after ectopicpregnancy. Am. J. Obstet Gynaecol1984;149:533.5. Stacey, CM, Munday. PE, Taylor-Robinson,D, etal, A longitudinal study of PID. Br. JObst Gynaecol, 1992;99:994.The ORION. Vol 27, May 2007www.orion-group.net/journalswww.orion-group.net/medicaljournal