Pelvic Inflammatory Disease

• Chlamydia is the commonest cause of PID.
  
• The risk of sterility is possibly as high as 15 - 20 % after a single attack.
  
• Gonorrhoea has been reported to be present in 14% of cases in a recent survey.
  

• As these patients will present with pelvic pain, perhaps with discharge, dyspareunia etc., ectopic pregnancy should be excluded by arranging an urgent beta-HCG.
  

• Antibiotic therapy must cover the range of possible infecting organisms and several drugs are the norm to cover the possibility of chlamydia, gonorrhoea, anaerobes etc.
• oral oflaxacin plus metronidazole for 14 days, both taken in a dose of 400mg. twice daily
• alternative regime is ceftriaxone 250mg. i.m. or cefoxitin 2gm. i.m. with oral probenecid 1gm.
• This initial treatment to be followed by oral doxycycline 200 mg. b.d. and metronidazole 400 mg. b.d. for fourteen days.
  
• Patients should be reviewed after 72 hours.
• If the condition is mild an IUCD can be left in place.
  
• If it is more severe, it should be removed.
  
• Pelvic inflammatory disease is an absolute contra-indication to the insertion of an IUCD at the time.

Category: Gynecology Notes