- PID is defined as the inflammation of the uterus, fallopian tubes, ovaries and pelvic peritoneum. It is also known as lower abdominal pain syndrome. It commonly occurs as a result of infection ascending from the cervix. It can also occur as a result of trans-cervical procedure.
- Common symptoms and signs of PID include lower abdominal pain and tenderness, painful micturation, painful coitus, abnormal vaginal discharge, menometrorrhagia, fever and sometime nausea and vomiting.
- Common etiologies of PID are Neisseria gonorrhoeae, Chlamydia trachomatis and Anaerobic bacteria
- Delayed or inadequately treated PID may lead to chronic lower abdominal pain, pelvic abscess, ectopic pregnancy, dysmenorrhea and infertility.
Management and Treatment of PID (see flow chart 12.3)
In-patient treatment of PID
All patients with PID who have fever of body temperature ≥ 380C should be admitted for closer care. The recommended in-patient treatment options for PID are as follows:
Regimen 1:
D: Cefixime 400mg 6 hourly
AND
A: Doxycycline 100 mg PO or IV, 12 hourly
AND
A: Metronidazole, 400mg PO or by IV, 12 hourly
Regimen 2:
A: Inj Ceftriaxone, 1 gm IM, once daily
AND
A: Doxycycline, 100mg PO or IV, 12 hourly
AND
A: Metronidazole, 400 PO or IV 12 hourly
Regimen 3:
S: Clindamycin, 900 mg IV, 8 hourly AND
A: Gentamicin, 1.5 mg/kg IV, 8 hourly
| NOTE: For all three regimens, therapy should be continued until at least two days after the patient has improved and then be followed by doxycycline, 100 mg PO 12 hourly for 14 days.
• Patients taking metronidazole should be cautioned to avoid alcohol. • Doxycycline 100mg is contraindicated in pregnancy. |
