How to approach PID (pelvic inflammatory disease) ?

MBBS
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What are the Diagnostic and management criteria of PID?
Tell me CDC regimen.

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Clinical finding
● Cervical motion tenderness.
● Uterine or adnexal tenderness.
● Blood and urine tests may be used to rule out other conditions.
● Lower abdominal pain.

Management of PID
● Treating the infection with antibiotics

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Diagnosis (CDC Clinical Criteria):

Diagnose PID if a woman presents with pelvic/lower abdominal pain and ANY ONE of the following on bimanual exam:

  1. Cervical motion tenderness
  2. Uterine tenderness
  3. Adnexal tenderness

Additional (supportive) findings:

  • Fever >38.3°C
  • Abnormal cervical/vaginal discharge
  • Elevated ESR or CRP
  • Lab-documented chlamydia/gonorrhea
  • TVS showing tubo-ovarian abscess, hydrosalpinx

CDC Outpatient Management Regimen:

  • Ceftriaxone 500 mg IM single dose (1 g if >150 kg)
  • Doxycycline 100 mg PO twice daily for 14 days
  • ± Metronidazole 500 mg PO twice daily for 14 days (recommended for anaerobic coverage)
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PID can be difficult to treat. So proper follow up is necessary.

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Diagnostic Criteria:
Based on the symptoms such as lower abdominal pain, bilateral adnexal tenderness, cervical motion tenderness, abnormal vaginal discharge, abnormal cervical discharge, any infection.
Management criteria:
Antibiotics- Ceftriaxone(IM)/Cefoxitin+Doxycycline(bd)
Oral and parenteral regimens.
Both the partners should be treated, avoid intercourse during the treatment.
CDC Regimen:
Ceftriaxone/Any third-generation Cephalosporin+Doxycycline+/- Metronidazole.
Ceftriaxone- 50mg-IM
Doxycycline-100mg-Oral-bd-14 days
Metronidazole -500mg-Oral-bd-14 days

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PID Diagnosis (CDC criteria)

Lower abdominal/pelvic pain + cervical motion tenderness OR uterine tenderness OR adnexal tenderness

Supportive: fever, abnormal discharge, high ESR/CRP, positive gonorrhea/chlamydia tests

PID Management

  1. Start antibiotics immediately on clinical suspicion
  2. Admit if severe, pregnant, or tubo-ovarian abscess

CDC Treatment Regimens:

Outpatient:
1)Ceftriaxone 500 mg IM once
2) Doxycycline 100 mg orally twice daily for 14 days
± Metronidazole 500 mg orally twice daily for 14 days

Inpatient:

  1. Cefoxitin 2 g IV q6h + Doxycycline 100 mg IV/PO q12h
    OR
  2. Clindamycin 900 mg IV q8h + Gentamicin IV/IM
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