So then, how do we treat PID?
Well, fortunately we have regimens
to treat most patients as an outpatient.
We would hospitalize patients only for clinically severe disease
(high fever, nausea, vomiting)
or patients unable to tolerate or follow an outpatient oral regimen.
That includes a sizeable minority of individuals.
We would certainly, for the safety of mother and baby,
hospitalize all pregnant women with PID.
One of the major concerns is,
"Is there pus that needs to be drained -- a tubo-ovarian abscess?"
So they would need to be admitted because antibiotics will fail
to resolve a big abscess.
The antibiotics don't penetrate well,
and the abscess needs,
as we say in medicine, fresh air and sunshine -- it needs drainage.
And then sometimes acute appendicitis is in the differential diagnosis.
And when a physician can't exclude appendicitis,
it would be prudent to admit the patient.
Pelvic rest is another form of therapy.
It's very, very important
to resolve this process
and so in terms of treating patients with antibiotics,
for outpatients, we use a combination of
intramuscular and oral regimens.
And the classic regimen is that of ceftriaxone
250 milligrams in a single dose
and as you remember, this is a treatment for gonorrhea.
We also add doxycyline, twice a day for 14 days
and this will cover our chlamydia
and mycoplasma organisms, if they're present.
We also add metronidazole.
Metronidazole is a wonderful agent
to treat anaerobic organisms,
which may be involved in this infection, as I mentioned.
And also it is a treatment for bacterial vaginosis that might be present.
Another regimen that's commonly used
would be that of cefoxitin
plus probenecid, to keep the levels of cefoxitin high,
Now for inpatients, we're going to be using essentially IV cefoxitin
every 12 hours or every 6 hours
plus doxycycline every 12 hours
or clindamycin plus gentamicin
which will cover the aerobic Gram-negative rods and the anaerobes,
and some alternative parenteral regimen.
One choice, for example, would be
which is a beta-lactamase inhibitor
which covers anaerobes very, very well.
and then the doxycycline.
So we would expect patients to improve within 3 days.
If there's no improvement after our outpatient intramuscular or oral therapy,
we would then hospitalize and re-assess our antibiotic regimen,
and consider diagnostic laparoscopy.
We would also repeat the tests for
Neisseria gonorrhoeae and Chlamydia trichomatis,
and then 3 months after treatment, we would retest again.
So we would expect, clinical improvement within 3 days
another important thing would be to counsel our patients
about the problems and complications
of pelvic inflammatory disease.
And we would have to honestly tell the patients
there is an increase incidence of ectopic pregnancy
because of the scarring of the fallopian tubes
and the adhesions that develop as part of this process.
So in terms of preventing further episodes of PID,
we'd recommend that a person who's been exposed
to a woman with PID during 60 days
before the onset of symptoms,
should be tested for gonorrhea and chlamydia.
Now, for a woman whose last sexual intercourse
is more than 60 days,
we would recommend that we treat the most recent sex partner
for both gonorrhea and chlamydia empirically.
We would also recommend abstinence from sex
until a therapy has been completed,
and the symptoms have resolved completely
for both woman and for her partner.
And this bring us to our conclusion
of the discussion of pelvic inflammatory disease.