Pelvic Inflammatory Disease (PID) is often missed and taken for granted by most women until they see severe symptoms that call their full attention.

PID is one of the leading causes of infertility worldwide and that is why treatment at the onset of the disease is very important. And since PID is characterized by an ascending infection of the Endometrium, Fallopian Tubes and sometimes the Peritoneum and the Liver (in cases of abscess formation), early treatment should be taken to prevent serious complications.

The ascending nature of the infection is believed to be caused by the traveling sperm during intercourse, due to surgical implants like the intra-uterine device (IUD), vaginal douching, poor cervical mucus protection, lack of endogenous good bacteria and cervical opening during menstruation with retrograde menstrual back flow.

patient with pidPID is often associated with 85% of sexually active women who do not practice safe sex and are intimate to multiple sexual partners.

Chronic PID is usually caused by microorganisms like: Chlamydia, Gonorrhea, Gardnella and rarely by Mycobacterium Tuberculosis too.

Due to the severity of the condition in Chronic PID and the difficulty of diagnosis to confirm it, the Centers for Disease Control and Prevention (CDC) made recommendations that a low threshold on PID diagnosis should be done, especially with sexually active young women.

CDC has authored the guidelines in the empirical treatment of PID, creating three groups to stratify the criteria. The three groups are:

Group 1
Minimum criteria (symptoms upon assessment):

  • Uterine or Adnexal Tenderness
  • Cervical Motion Tenderness

Group 2
Minimum criteria plus the following additional findings:

  • Oral Temperature > 38.3ºC (101ºF)
  • Abnormal Cervical or Foul Smelling Vaginal Mucopurulent Secretions
  • Elevated Erythrocyte Sedimentation Rate
  • Elevated C-Reactive Protein
  • Laboratory Evidence of Cervical Infection with Nisseria Gonorrhea or Chlamydia Trachomatis (Culture or DNA probe) and of other Microorganisms

Group 3
Specific criteria for PID based on procedures that may be appropriate for some patients are as follows:

  • Laparoscopic Confirmation
  • Transvaginal Ultrasonography (or MRI) showing thickened, fluid-filled tubes with/without free pelvic fluid or Tubo-Ovarian complex
  • Endometrial Biopsy showing Endometritis

Usually patients are treated on an outpatient basis, but, there are cases requiring confinement and further evaluation like:

  • Patients with uncertain diagnosis
  • Presence of pelvic abscess on ultrasound
  • Pregnancy
  • Failure of outpatient medication and management
  • Inability to tolerate outpatient medication
  • Severe symptoms of nausea and vomiting preventing successful medication regimen
  • Compromised immune system as in cases with HIV infection
  • No signs of improvement after 72 hours with outpatient therapy

Oral antibiotic medications include: Azithromycin, Ceftriaxone, Cefoxitin, Cefotetan, Doxycycline, Clindamycin, Metronidazole, Gentamicin, Meropenem and Probenecid. If however, outpatient medication fails, a surgical procedure of Laparoscopic Pelvic Lavage, Abscess Drainage and Lysis of Adhesions may be necessary.