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Pelvic Infammatory

Disease

Stella Marie L. Jose, M.D.,

M.H.P.Ed., F.P.O.G.S.

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Etiology scension o! microorganisms !rom t"e

lo#er genital tract $cervi% and vagina&

into t"e '((er genital tract. Organisms involved) N. gonorrhea, C. trachomatis, genital

mycoplasma, anaerobic and aerobic

bacteria from the endogenous vaginalora- Prevotella, Peptostreptococcus,Gardnerella vaginalis, E. coli, Hemophilusinuena, aerobic !treptococcus

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Pat"ogenesis * Factors t"at contri+'te to t"e ascension o!

+acteria !rom t"e endocervi% and vagina)

. -terine instr'mentation . Hormonal c"anges d'ring menses t"at

res'lts in loss o! t"e mec" +arrier t"at "el(s(revent t"e ascension o! +act

/. 0etrograde menstr'ation !avor t"eascension o! +acteria *. Individ'al org "ave (otential vir'lence

!actors

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In normal (atients) Endocervical canal and t"e cervical

m'co's (l'g are ma1or +arriers t"at(rotect t"e '((er genital tract In!ection #it" Neisseria gonorrhea and

Chlamydia trachomatis +rea2do#n o!

t"e cervical m'co's (l'g 345 damage to t"e normal clearance

mec"anism assoc #6 ciliated cells in t"eendometri'm and !allo(ian t'+es

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345 may !acilitate t"e ascension o!S7D organisms and ot"er aero+es

t"r' en8ymatic degradation +y(roteolytic en8ymes assoc #it" 345assoc +acteria

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Minim'm 9riteria !or t"e

d% o! PID . dne%al tenderness

. 9ervical motion tenderness

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dditional criteria Oral tem( :/;./<9 Presence o! =39 on saline microsco(y

Elevated ES0, 90P La+ doc'mentation o! cervical in!ection #it"

>eisseria, and 9"lamydia Histo(at" evidence o! endometritis on em +%

 74S or M0I s"o#ing t"ic2ened f'id ?lledt'+es #it" or #it"o't !ree (elvic f'id or 7O La(arosco(ic a+normalities consis #it" PID

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Oral 7reatment o! PID

$9D9& 0egimen

Ofo%acin *@@ mg 3ID % * d or

Levofo%acin A@@ mg OD % * d

Pl's Metronida8ole A@@ mg 3ID %

* d

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Oral 7reatment 0egimen 3

9e!tria%one A mtg IM once or

9e!o%itin .@ g IM (l's (ro+enecid g O0ot"er (arenteral /rd gen 9e("alos(orin$9e!ti8o%ime or 9e!ota%ime&

PL-S

Do%ycycline @@ mg +id % * d #it" or#it"o't Metronida8ole A@@ mg 3ID % *days

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0ecommended treatment

sc"ed'le !or in (atient$9D9& 0egimen

9e!otetan g I4 B "rs or

9e!o%itin g I4 B C "o'rs (l's Do%ycycline @@ mg I4 or PO B "o'rs

$0egimen given !or at least * "rs a!ter

(t clinically im(roves. !ter d6c5contin'e Do%ycyline @@ mg PO 3ID %* d

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In (atient 0egimen 3 9lindamycin @@ mg I4 B ; "rs (l's

Gentamicin LD mg62g d +ymaintenance dose .A mg62g B ; "rs

$0egimen contin'ed !or at least * "rsa!ter (t im(roves. !ter disc"arge, give)

9linda *A@ mg ID % * days or Do%ycycline @@ mg 3ID % * days

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9riteria !or "os(itali8ation . S'rgical emergencies s'c" as

a((endicitis cannot +e r'led o't.

. Patient is (regnant. /. Patient does not res(ond clinically to

oral antimicro+ials *. Patient 'na+le to !ollo# or tolerate

OPD regiment A. Patient "as severe illness, na'sea,

vomiting or "ig" !ever

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9riteria !or "os(itali8ation C. Patient "as t'+oovarian a+scess

. Patient is imm'nocom(romised$HI4 #it" lo# 9D* co'nts,

imm'nos'((ressive t"era(y