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"What is pelvic inflammatory disease? Pelvic inflammatory disease (PID) is an infection that passes from the vagina through neck of the womb (cervix), the womb (uterus) and up to the Fallopian tubes. The ovaries are sometimes also involved.  Bacteria and other micro-organisms can find their way through the vagina and the cervix to the internal reproductive organs. A bacterial infection can cause inflammation in these organs and their surroundings. This most commonly occurs in the Fallopian tubes. What causes PID? In some women, PID may result f\u00BArom a termination of pregnancy or following childbirth. Occasionally, it may be as a result of having sex with a new partner. But often no specific reason can be found. In the UK the &amp;#039;bug&amp;#039; most commonly responsible for PID is chlamydia. What are the symptoms of PID? PID causes tenderness and pain in one or both sides of the lower abdomen. At the same time, it can cause fever and general discomfort. Finally, the infection can be accompanied by heavy, painful periods and sometimes a vaginal discharge.  How does the doctor make a diagnosis? If, in a pelvic examination, the doctor detects tenderness and perhaps even a lump next to the uterus, then PID is a possible cause. Blood tests can also be used to detect signs of infection.  Usually these symptoms and signs of infection are sufficient for the doctor to make a diagnosis of PID but, sometimes, it may be necessary to also examine the inside of the pelvis using laparoscopy to detect any inflammatory changes.  Samples are also taken from the neck of the womb to try to identify the organism responsible for the infection. How is PID treated? The doctor will normally prescribe antibiotics and advise the patient to keep warm and rest at home - hospitalisation is not usually necessary. In most cases, the inflammation will subside in a week or two. However, if the pain and soreness remain, this could be a sign that the infection has not gone away and might even have returned.  Fortunately, with proper treatment, this is uncommon. If Chlamydia is detected then the woman&amp;#039;s sexual partner should also be tested. If he is infected, he will also require treatment.  What complications may arise from PID?  Even though PID is a relatively harmless condition, if it is not treated quickly and effectively, it can result in permanent damage to the Fallopian tubes. This makes it more difficult for eggs and sperm to pass through and increases the risk of infertility or an ectopic pregnancy.  If the first or subsequent episodes of inflammation are not adequately treated then the condition can become chronic. If this happens, abscesses can form in the pelvis and surgery is often required. This may involve the loss of a Fallopian tube, an ovary or, occasionally, the removal of the womb in a hysterectomy. Fortunately, most women seek advice early and treatment is prompt and appropriate. Treatment of acute pelvic inflammatory disease \u2013 Royal College of Obstetricians and Gynaecologists guideline summary 3. Making a diagnosis of acute PID 3.1 Clinical A low threshold for empiric treatment of PID is recommended because of the lack of definitive clinical diagnostic criteria and because the potential consequences of not treating of PID are significant. In clinically severe cases, referral to hospital for treatment and further investigation is advisable. 3.2 Microbiological Women with suspected PID should be tested for gonorrhoea and chlamydia. 4. Starting treatment 4.1 How should PID be managed in the outpatient setting? Information on current and recent medication should be obtained. Interactions between antibiotic therapy and hormonal contraception and other patient medications should be assessed and appropriate action taken. 48 Outpatient antibiotic treatment should be commenced as soon as the diagnosis is suspected.  Outpatient antibiotic treatment should be based on one of the following regimens:   oral ofloxacin 400 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days38\u201341  intramuscular ceftriaxone 250 mg single dose, * followed by oral doxycycline 100 mg twice daily plus metronidazole 400 mg twice daily for 14 days.38,39,42\u201344 * Cefoxitin has a better evidence base for the treatment of PID than ceftriaxone but is not easily available in the UK. Ceftriaxone is therefore recommended.  When giving information to patients, the clinician should consider the following:  an explanation of what treatment is being given and its possible adverse effects   that following treatment fertility is usually maintained but there remains a risk of future infertility, chronic pelvic pain or ectopic pregnancy   repeat episodes of PID are associated with an exponential increase in the risk of infertility  future use of barrier contraception will significantly reduce the risk of PID   the need to screen her sexual contacts for infection to prevent her becoming reinfected  clinically more severe disease is associated with a greater risk of sequelae  the earlier treatment is given the lower the risk of future fertility problems.  4.2 What hospital treatment should be given and when should it be recommended?  surgical emergency cannot be excluded  clinically severe disease tubo-ovarian abscess  PID in pregnancy lack of response to oral therapy   intolerance to oral therapy.  Inpatient antibiotic treatment should be based on intravenous therapy which should be continued until 24 hours after clinical improvement and followed by oral therapy. Recommended regimens are:   ceftriaxone 2 g by intravenous infusion daily plus intravenous doxycycline 100 mg twice daily,* followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for a total of 14 days 11,38,39,43,44 * Oral doxycycline may be used if tolerated intravenous clindamycin 900 mg three times daily plus intravenous gentamicin,* followed by either  oral clindamycin 450 mg four times daily to complete 14 days OR  oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily to complete 14 days.11,39,43,44 * Gentamicin should be given as a 2 mg/kg loading dose followed by 1.5 mg/kg three times daily (or a single daily dose of 7 mg/kg may be substituted).  intravenous ofloxacin 400 mg twice daily plus intravenous metronidazole 500 mg three times daily for 14 days.  4.3 Treatment in pregnancy and in young women A pregnancy test should be performed in all women suspected of having PID to help exclude an ectopic pregnancy. Drugs known to be toxic in pregnancy, such as tetracyclines, should be avoided.  A combination of cefotaxime, azithromycin and metronidazole for 14 days may be used. The risks associated with metronidazole are uncertain but no confirmed associations with adverse outcomes have been reported.  4.4 Treatment in a woman with an intrauterine contraceptive device Consideration should be given to removing an intrauterine contraceptive device (IUD) in women presenting with PID, especially if symptoms have not resolved within 72 hours. 5. Other modes of treatment Surgical treatment should be considered in severe cases or where there is clear evidence of a pelvic abscess.  Consider drainage of an abscess and in noting its position, the possibility that the abscess may have arisen from the appendix or colon.  6. Management of sexual partner(s) of women with PID When a sexually transmitted infection is either proven or likely to be the cause of PID, the current sexual partner(s) should be contacted and offered health advice and screening for gonorrhoea and chlamydia. Referral of the index woman and her partner to a genitourinary medicine/sexual health clinic is recommended to facilitate contact tracing and infection screening. 7. Review of women with PID In the outpatient setting, review at 72 hours is recommended, particularly for those with a moderate or severe clinical presentation.  Failure to improve clinically suggests the need for further investigation, to exclude competing diagnoses, and may require admission for parenteral therapy and/or surgical intervention.  Further review 4 to 6 weeks after therapy may be useful to ensure:   adequate clinical response to treatment  compliance with oral antibiotics  screening and treatment of sexual contacts   awareness of the significance of PID and its sequelae   that a repeat pregnancy test is negative, if clinically indicated.  Repeat testing for gonorrhoea after treatment is recommended in those initially found to be infected unless sensitivity testing of the isolate confirms sensitivity to the prescribed antibiotic.  Repeat testing for chlamydia and gonorrhoea is appropriate in those in whom persisting symptoms, compliance with antibiotics and/or tracing of sexual contacts indicate the possibility of persisting or recurrent infection.  A repeat chlamydia and gonorrhoea test is not otherwise required.  8. Women who are infected with HIV Women with PID who are also infected with HIV should be treated with the same antibiotic regimens as women who are HIV negative. Women with HIV should be managed in conjunction with their HIV physician.  9. Contraception options and PID Women on hormonal contraception presenting with breakthrough bleeding should be screened for genital tract infection, especially C. trachomatis.  If a woman is likely to be at risk of future PID and requests an IUD for contraception, the LNG-IUS would be the most appropriate choice53. Section 4.4. Treatment in a woman with an intrauterine contraceptive device Consideration should be given to removing an intrauterine contraceptive device (IUD) in women presenting with PID, especially if symptoms have not resolved within 72 hours. Section 5. Other modes of treatment Consider drainage of an abscess and in noting its position, the possibility that the abscess may have arisen from the appendix or colon. Other people also read: Termination of pregnancy: what complications may arise from a termination? Childbirth: what are the phases of birth? Chlamydia: are there any symptoms? Endometriosis: is it painful?  Based on a text by Dr Erik Fangel Poulsen, gynaecologist  Last updated 12.02.2013 "^^<http://www.w3.org/2001/XMLSchema#string>
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