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Pelvic Inflammatory Disease

Updated : February 14, 2024





Background

Pelvic inflammatory disease is an inflammation of the upper genital tract caused due to infection that primarily affects sexually active young women. PID is often misdiagnosed and can be asymptomatic, chronic, or acute.

Various infectious processes that damage the fallopian tubes, endometrium, pelvic peritoneum, and ovaries are included in pelvic inflammatory disease (PID). Sexually transmitted infections cause most PID cases, but organisms associated with bacterial vaginosis have also been implicated.

Epidemiology

PID most usually affects females between the ages of 15 and 25. It is estimated that sexually active women 18 to 44 years of age had a self-reported lifetime PID prevalence of 4.4%. Women with high-risk factors, such as a history of sexually transmitted illness, have the most significant rate of self-reported lifetime cases.

With no STD history, black women have a lifetime prevalence of 6% and 2.7% in white women. PID is associated with sexually transmitted diseases. Routine screening for gonorrhea and chlamydial infections is necessary to reduce the incidence of PID.

Anatomy

Pathophysiology

It is an ascending infection that develops in the lower genital tract and spreads. Inflammatory damage by an infection of the upper female genital tract causes adhesions, scarring, and a partial or complete constriction of the fallopian tubes.

As a result, the fallopian tube lining loses its ciliated epithelial cells, which could hinder ovum transfer and raise the risk of infertility and ectopic pregnancy. Adhesions can also cause persistent pelvic pain.

Etiology

PID results from an infection that rises from the cervix. The bacteria which cause the infection are transferred sexually in 85% of cases. The most prevalent pathogens among the aggravating agents are the bacterium Neisseria gonorrhoeae or Chlamydia trachomatis. 10% to 15% of women with endocervical C. trachomatis or N. gonorrhoeae eventually develop the pelvic inflammatory disease.

PID caused by gonorrhea is typically more intense than PID from other causes. Chlamydia PID is more likely to result in subclinical PID since it is less likely to produce symptoms. While subclinical PID may not show symptoms, it can have adverse long-term effects.

Certain cervical microbes, such as Mycoplasma genitalium, are assumed to be associated with this condition. Bacteroides and Peptostreptococcus species are associated with bacterial vaginosis. Respiratory pathogens such as Streptococcus pneumonia, Haemophilus influenza, and Staphylococcus aureus have been associated with cases of acute PID.

Genetics

Prognostic Factors

The disease outcome depends on prevention strategy and routine screening for women under 25 and pregnant women. Behavioral therapy is advised for adults and adolescents at high risk of sexually transmitted infections. Late treatment is profoundly related to poor outcomes and several complications.

Even with prompt treatment, long-term problems can arise. Females between the ages of 20 and 24 are 8.5% likely to have ectopic pregnancies, 18% more likely to experience chronic discomfort, and 16.8% more inclined to struggle with infertility.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

cefotaxime

1 g IM or IV given every 12hrs for mild conditions
1-2 g IM or IV every 8hrs moderate to severe infections
2 g IV every 6-8hrs high dosing for infections
2 g IV every 4hrs for life-threatening infections
12 g is the maximum dose required per day



ceftriaxone

1-2 g IV or IM was given once a day or in equally divided doses 2x a day
maximum duration of therapy is 4-14 days
prolonged treatment recommends for complicated infections



clindamycin 

900

mg

Intravenous (IV)

3 times a day along with gentamicin 2 mg/kg

; following 1.5 mg/kg 3 times a day
after discharge continue with doxycycline 100 mg orally 2 times a day for 14 days of therapy



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



azithromycin 

Provide an antibiotic with anaerobic activity together with azithromycin if it is thought that anaerobic germs are causing the illness.



erythromycin lactobionate 

Administer 500 mg intravenous every 6 hour for 3 days and followed by 500 mg orally every 12 hours



probenecid 

Administer 1 gram orally along with a single dose of 2 grams of cefoxitin via intramuscular injection



sulfisoxazole 

Oral administration of 500 mg 4 times a day for 21 days, where it is used in combination with ceftriaxone



Dose Adjustments

Not Available

ceftizoxime 

In-patients with the pelvic inflammatory disease will receive 2 g IV three times a day after improvement, which makes the way for the appropriate antibiotic therapy via oral administration that should continue for 14 days
1 g via IM is administered in outpatient settings, which is followed by doxycycline oral for 14 days



Dose Adjustments

Renal Dose Adjustment
In case of renal insufficiency, the usual dose of ceftizoxime depends on the CrCl. If the CrCl is below 5 mL/min, then 0.25-0.5 g a day or 0.5-1 g via IV or IM in 2 days after undergoing dialysis. Loading dose is standard in renal insufficiency, which is 0.5-1 g. 0.25 -1g twice a day if CrCl falls between 5 and 49 mL/min and 0.5 – 1.5 g thrice a day if CrCl is between 50 and 79 mL/min

trovafloxacin 

300mg intravenous every 24 hours as required, followed by a maintenance dose of 200mg orally per day for 2 weeks.



 

sulfisoxazole 

100 mg/kg/day of oral administration in divided doses four times a day, which is further recommended to be combined with ceftriaxone in infants two months or older



Dose Adjustments

Not Available

sulfisoxazole 

100 mg/kg/day of oral administration in divided doses four times a day, which is further recommended to be combined with ceftriaxone in infants two months or older



Dose Adjustments

Not Available

 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK499959/

https://www.cdc.gov/mmwr

Pelvic Inflammatory Disease

Updated : February 14, 2024




Pelvic inflammatory disease is an inflammation of the upper genital tract caused due to infection that primarily affects sexually active young women. PID is often misdiagnosed and can be asymptomatic, chronic, or acute.

Various infectious processes that damage the fallopian tubes, endometrium, pelvic peritoneum, and ovaries are included in pelvic inflammatory disease (PID). Sexually transmitted infections cause most PID cases, but organisms associated with bacterial vaginosis have also been implicated.

PID most usually affects females between the ages of 15 and 25. It is estimated that sexually active women 18 to 44 years of age had a self-reported lifetime PID prevalence of 4.4%. Women with high-risk factors, such as a history of sexually transmitted illness, have the most significant rate of self-reported lifetime cases.

With no STD history, black women have a lifetime prevalence of 6% and 2.7% in white women. PID is associated with sexually transmitted diseases. Routine screening for gonorrhea and chlamydial infections is necessary to reduce the incidence of PID.

It is an ascending infection that develops in the lower genital tract and spreads. Inflammatory damage by an infection of the upper female genital tract causes adhesions, scarring, and a partial or complete constriction of the fallopian tubes.

As a result, the fallopian tube lining loses its ciliated epithelial cells, which could hinder ovum transfer and raise the risk of infertility and ectopic pregnancy. Adhesions can also cause persistent pelvic pain.

PID results from an infection that rises from the cervix. The bacteria which cause the infection are transferred sexually in 85% of cases. The most prevalent pathogens among the aggravating agents are the bacterium Neisseria gonorrhoeae or Chlamydia trachomatis. 10% to 15% of women with endocervical C. trachomatis or N. gonorrhoeae eventually develop the pelvic inflammatory disease.

PID caused by gonorrhea is typically more intense than PID from other causes. Chlamydia PID is more likely to result in subclinical PID since it is less likely to produce symptoms. While subclinical PID may not show symptoms, it can have adverse long-term effects.

Certain cervical microbes, such as Mycoplasma genitalium, are assumed to be associated with this condition. Bacteroides and Peptostreptococcus species are associated with bacterial vaginosis. Respiratory pathogens such as Streptococcus pneumonia, Haemophilus influenza, and Staphylococcus aureus have been associated with cases of acute PID.

The disease outcome depends on prevention strategy and routine screening for women under 25 and pregnant women. Behavioral therapy is advised for adults and adolescents at high risk of sexually transmitted infections. Late treatment is profoundly related to poor outcomes and several complications.

Even with prompt treatment, long-term problems can arise. Females between the ages of 20 and 24 are 8.5% likely to have ectopic pregnancies, 18% more likely to experience chronic discomfort, and 16.8% more inclined to struggle with infertility.

cefotaxime

1 g IM or IV given every 12hrs for mild conditions
1-2 g IM or IV every 8hrs moderate to severe infections
2 g IV every 6-8hrs high dosing for infections
2 g IV every 4hrs for life-threatening infections
12 g is the maximum dose required per day



ceftriaxone

1-2 g IV or IM was given once a day or in equally divided doses 2x a day
maximum duration of therapy is 4-14 days
prolonged treatment recommends for complicated infections



clindamycin 

900

mg

Intravenous (IV)

3 times a day along with gentamicin 2 mg/kg

; following 1.5 mg/kg 3 times a day
after discharge continue with doxycycline 100 mg orally 2 times a day for 14 days of therapy



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



metronidazole 

500 mg per orally every 12 hours for 14 days in combination with levofloxacin or ofloxacin



azithromycin 

Provide an antibiotic with anaerobic activity together with azithromycin if it is thought that anaerobic germs are causing the illness.



erythromycin lactobionate 

Administer 500 mg intravenous every 6 hour for 3 days and followed by 500 mg orally every 12 hours



probenecid 

Administer 1 gram orally along with a single dose of 2 grams of cefoxitin via intramuscular injection



sulfisoxazole 

Oral administration of 500 mg 4 times a day for 21 days, where it is used in combination with ceftriaxone



Dose Adjustments

Not Available

ceftizoxime 

In-patients with the pelvic inflammatory disease will receive 2 g IV three times a day after improvement, which makes the way for the appropriate antibiotic therapy via oral administration that should continue for 14 days
1 g via IM is administered in outpatient settings, which is followed by doxycycline oral for 14 days



Dose Adjustments

Renal Dose Adjustment
In case of renal insufficiency, the usual dose of ceftizoxime depends on the CrCl. If the CrCl is below 5 mL/min, then 0.25-0.5 g a day or 0.5-1 g via IV or IM in 2 days after undergoing dialysis. Loading dose is standard in renal insufficiency, which is 0.5-1 g. 0.25 -1g twice a day if CrCl falls between 5 and 49 mL/min and 0.5 – 1.5 g thrice a day if CrCl is between 50 and 79 mL/min

trovafloxacin 

300mg intravenous every 24 hours as required, followed by a maintenance dose of 200mg orally per day for 2 weeks.



sulfisoxazole 

100 mg/kg/day of oral administration in divided doses four times a day, which is further recommended to be combined with ceftriaxone in infants two months or older



Dose Adjustments

Not Available

sulfisoxazole 

100 mg/kg/day of oral administration in divided doses four times a day, which is further recommended to be combined with ceftriaxone in infants two months or older



Dose Adjustments

Not Available

https://www.ncbi.nlm.nih.gov/books/NBK499959/

https://www.cdc.gov/mmwr