Professional Documents
Culture Documents
POTENTIAL CAUSES
Most cases of PID can be categorized as sexually transmitted or endogenous and are
associated with more than one organism or condition including:
sexual contact
history of STI
TYPICAL FINDINGS
Sexual Health History
sexual contact
Physical Assessment
Cardinal Signs
fever >38C
dyspareunia
urinary frequency
pelvic pain
nausea or vomiting
Special Considerations
It is important to rule out other potential causes of lower abdominal pain including ectopic
pregnancy, ovarian cysts, and gastrointestinal causes including appendicitis.
Diagnostic Tests
cervical or vaginal swab for nucleic acid amplification test (NAAT) for GC and CT
AND
cervical swab for GC culture & sensitivity (C&S)
AND
urine pregnancy test
AND
vaginal swabs for
vaginal pH
AND
bimanual exam for tenderness
In addition to the diagnostic tests above, offer clients routine STI and HIV screening.
BCCDC Clinical Prevention Services
Reproductive Health Decision Support Tool Non Certified Practice
CLINICAL EVALUATION
Immediately refer all clients who present with suspected PID to a physician or NP for
immediate assessment and treatment to avoid complications.
Note: When indicated, IUD removal is managed by a physician or NP. For moderate PID,
IUD removal during treatment is not necessary unless there is no clinical improvement
72 hours after the onset of recommended antibiotic treatment.
preserve fertility
treat infection
alleviate symptoms
pregnancy
First Choice
cefixime 800 mg PO in a single
dose
and
doxycycline 100 mg PO bid for 10
days
First Choice
NOTES
1. Treatment for PID covers for both gonorrhea and Chlamydia
infections.
and
and
and
and
metronidazole 500 mg PO bid for 10 days
and
Second Choice
Second Choice
and
azithromycin 1 gm PO in a single
dose and 1 gm PO in a single dose
in 1 week (for a total of 2 doses
given 7 days apart)
OR
and
and
metronidazole 500 mg PO bid for 10 days
OR
and
and
13.
azithromycin 1 gm PO in a single
dose and 1 gm PO in a single dose
in 1 week (for a total of 2 doses
given 7 days apart)
and
metronidazole 500 mg PO bid for 10 days
PREGNANT OR BREASTFEEDING
Refer all pregnant or breastfeeding clients to a physician or NP.
recommend the client return for re-assessment or seek medical care if symptoms have not
resolved by 3 -7 days after the onset of treatment
if test results are positive for gonorrhea and/or Chlamydia, refer to appropriate DST for
follow-up
POTENTIAL COMPLICATIONS
Fitz-Hugh-Curtis syndrome
tubo-ovarian abcess
ectopic pregnancy
recurrent PID
CLIENT EDUCATION
Counsel client:
to return or seek medical care for reassessment of pelvic tenderness if symptoms have
not resolved by 3-7 days after starting treatment.
to seek urgent medical care if symptoms worsen.
regarding the appropriate use of medications (dosage, side effects, and need for retreatment if dosage not completed).
to avoid sexual contact until the client and their partner(s) have completed screening
and treatment.
to inform all sexual contacts within the last 60 days (or the last sexual contact if no
contacts in previous 60 days) that they require testing and treatment.
regarding harm reduction measures (i.e., condom use).
regarding the complications from untreated PID.
regarding the co-infection risk for HIV when another STI is present.
regarding the asymptomatic nature of STI and HIV.
CONSULTATION OR REFERRAL
refer/consult for all clients who present clinically with suspected PID to physician or
NP
refer clients who are experiencing persistent and/or worsening symptoms after
treatment has been initiated to a physician or NP
DOCUMENTATION
REFERENCES
Altunyurt, S., Demir, N., Posaci, C. (2003). A randomized controlled trial of coil removal
prior to treatment of pelvic inflammatory disease. European Journal of Obsterics &
Gynecology and Reproductive Biology 107(2003) p. 81-84.
British Columbia Centre for Disease Control. (2014). British Columbia treatment guidelines.
Sexually transmitted infections in adolescents and adults. B.C. Centre for Disease Control.
Retrieved from: http://www.bccdc.ca/NR/rdonlyres/46AC4AC5-96CA-4063-A5630BA9F4A0A6E9/0/CPS_BC_STI_Treatment_Guidelines_20112014.pdf
Centers for Disease Control, Atlanta. (2010). Intrauterine contraceptive cevices. Retrieved
from: http://www.cdc.gov/std/treatment/2010/pid.htm
Darville, T. (2013). Pelvic inflammatory disease: Identifying research gaps proceedings of
a workshop sponsored by Department of Health and Human Services/ National
Institutes of Health/ National Institute of Allergy and Infectious Diseases, November
3-4 2011. Sexually Transmitted Diseases (40)10 pp. 761-767
Haggerty, C., Hillier, S., Bass, D., Ness, R. (2004). Bacterial vaginosis and anaerobic
bacteria are associated with endometritis. Clinical Infectious Disease 39 p. 990-995.
Hillis, S., Joesoef, R., Marchbanks, P., Wasserheit, J., Cates, W., Westrom, L. (1993).
Delayed care of pelvic inflammatory disease as a risk facto for impaired fertility.
American Journal of Obstetrics and Gynecology 168(5) p. 1503-1509.
Holmes, K., Sparling, P., Stamm, W., Piot, P., Wasserheit, J., Corey, L., Cohen, M., Watts, H.
(2008). Sexually transmitted disease (4th ed). Toronto, ON: McGraw Hill Medical.
Ness, R., Trautmann, G., Richter, H., Randall, H., Peipert, J., Nelson, D., Schubeck, D.,
McNeeley, S., Trout, W., Bass, D., Soper, D. (2005). Effectiveness of treatment
strategies of some women with pelvic inflammatory disease: A randomized trial.
Obstetrics & Geynecology 106(3) p. 573-580.
Public Health Agency of Canada. (2008) Pelvic inflammatory disease. Canadian Guidelines on
Sexually Transmitted Infections. Retrieved from: www.phac-aspc.gc.ca/stdmts/sti_2006/pdf/pid06_e.pdf
Ross, J., Judlin, P., Nilas, L. (2008 update). European guideline for the management of pelvic
inflammatory disease. PID Treatment Guidelines. Retrieved from:
www.iusti.org/regions/europe/PID_v5.pdf
Short, V., Totten, P., Ness, R., Astete, S., Kelsey, S., Haggerty, C. (2009). Clinical
presentation of Mycoplasma genitalium infection versus Nesisseria gonorrhoeae
BCCDC Clinical Prevention Services
Reproductive Health Decision Support Tool Non Certified Practice
10