Pelvic Inflammatory Diseases (PID)

Clinical Description

Signs and symptoms: A triad of lower abdominal pain, abnormal vital signs (particularly fever and tachycardia) and peritonism (guarding or rebound tenderness with cervical motion and adnexal tenderness)

Patients additionally have positive risk screen and abnormal vaginal discharge

Other additional factors are

• Failure to respond to syndromic treatment regime within 72 hours
• Presence of tender pelvic mass which may be an abscess or an ectopic pregnancy
• History or suspicion of recent induced abortion, delivery or miscarriage
• Active vaginal bleeding
• Missed, overdue or delayed period

Pregnancy

• Heavy menstrual bleeding
• Vomiting

Note: The patient should be admitted

Treatment

• If deranged vital signs, dehydration etc:
• Give IV fluids
• Offer analgesia
• Parenteral antibiotics.

o 1st line

• Ceftriaxone 2g IV daily
• Metronidazole 500mg IV 8 hourly
• Alternatively
• Gentamicin 240mg IV daily
• Metronidazole 500mg IV 8 hourly
• Ampicillin 1g IV 8 hourly
• When improved and able to swallow switch to oral antibiotics:
• Doxycycline 100mg 12 hourly and
• Metronidazole 400mg 8 hourly for 10 days
• Analgesic
• If pain is severe:
• Give Pethidine 100 mg IM then PRN

Notes:

• Post abortal sepsis and puerperal sepsis may present as acute PID. If these are recognized, the following must be done:
• Admit and treat with parenteral antibiotic therapy.
• If retained products of conception suspected, evacuate the uterus within 12 hours of antibiotic therapy regardless of the patient's temperature
• Provide supportive care such as blood transfusion, iv fluids and closely monitor vital signs.