PID
Ascending infection of the uterus, ovaries, fallopian tubes and peritoneal
tissues from spread of STD pathogens
Diagnosis
- Minimal requirements:
- Uterine or adnexal tenderness (unilateral or bilateral) OR
- Cervical motion tenderness
- Additional criteria to increase specificity:
- Temp>38.3
- Abnormal cervical or vaginal discharge
- Elevated ESR or CRP
- Laboratory evidence of GC and/or Chlamydial cervicitis
- Presence of white blood cells (WBC’s) on saline microscopy of vaginal
secretions
- may be associated with Fitz-Hugh-Curtis syndrome
Treatment
Hospitalization vs. outpatient therapy
- Outpatient RX:
- Ceftriaxone x 1 dose
- Doxycycline BID x 14 days
- With or without metronidazole BID x 14 days
- Inpatient RX:
- Cefotetan or Cefoxitin IV
- Doxycycline IV or PO
- Add metronidazole for tuboovarian abscess
Complications of PID
- Perihepatitis
- Tubo-ovarian abscess
- Chronic pelvic pain
- Tubal scarring
- Ectopic pregnancy
- Infertility
Key review points for STD's in general:
- Most common STD in adolescents = chlamydia; gonorrhea is #2
- CDC recommends testing all sexually active adolescents q year for
gonorrhea/chlamydia
- Neonatal conjunctivitis: topical PPX not effective for chlamydia.
Gonorrhea-requires IV cephalosporin; chlamydia-PO erythromycin; both need
saline irrigation
- Uncomplicated genital infections in adolescents/children > 8yrs: if poor
F/U or in areas of high incidence of concurrent infections, may use dual
therapy for gonorrhea & chlamydia without testing for both:
- Ceftriaxone x 1 (Ciprofloxacin or Ofoxacinx 1 on east coast) for
gonorrhea
- PLUS Doxycycline x 7 days or Azithromycinx 1 for chlamydia
- Complicated Gonococcal Infections require more prolonged therapy.
- Though the newer tests (PCR, LCR) are used routinely for testing of
adolescents, in the prepubertalchild evaluated for child abuse the gold
standard remains culture.
- Asymptomatic chlamydialinfection can persist for up to 3 years
- If febrile, r/o PID
CHLA Board Review 2005