Pelvic Inflammatory

Disease
Stella Marie L. Jose, M.D.,
M.H.P.Ed., F.P.O.G.S.

Etiology

Ascension of microorganisms from the

lower genital tract (cervix and vagina)
into the upper genital tract.
Organisms involved:
N. gonorrhea, C. trachomatis, genital
mycoplasma, anaerobic and aerobic
bacteria from the endogenous vaginal
flora- Prevotella, Peptostreptococcus,
Gardnerella vaginalis, E. coli, Hemophilus
influenza, aerobic Streptococcus

Pathogenesis

4 Factors that contribute to the ascension of

bacteria from the endocervix and vagina:
1. Uterine instrumentation
2. Hormonal changes during menses that
results in loss of the mech barrier that helps
prevent the ascension of bact
3. Retrograde menstruation favor the
ascension of bacteria
4. Individual org have potential virulence
factors

In normal patients:
Endocervical canal and the cervical
mucous plug are major barriers that
protect the upper genital tract
Infection with Neisseria gonorrhea and
Chlamydia trachomatis breakdown of
the cervical mucous plug
BV- damage to the normal clearance
mechanism assoc w/ ciliated cells in the
endometrium and fallopian tubes

BV- may facilitate the ascension of

STD organisms and other aerobes
thru enzymatic degradation by
proteolytic enzymes assoc with BVassoc bacteria

Minimum Criteria for the

dx of PID

1. Adnexal tenderness
2. Cervical motion tenderness

Additional criteria

Oral temp >38.3*C

Presence of WBC on saline microscopy
Elevated ESR, CRP
Lab documentation of cervical infection with
Neisseria, and Chlamydia
Histopath evidence of endometritis on em bx
TVS or MRI showing thickened fluid filled
tubes with or without free pelvic fluid or TOA
Laparoscopic abnormalities consis with PID

Oral Treatment of PID

(CDC)

Regimen A
Ofloxacin 400 mg BID x 14 d or
Levofloxacin 500 mg OD x 14 d
Plus Metronidazole 500 mg BID x
14 d

Oral Treatment

Regimen B
Ceftriaxone 125 mtg IM once or
Cefoxitin 2.0 g IM plus probenecid 1 g OR
other parenteral 3rd gen Cephalosporin
(Ceftizoxime or Cefotaxime)
PLUS
Doxycycline 100 mg bid x 14 d with or
without Metronidazole 500 mg BID x 14
days

Recommended treatment
schedule for in patient
Regimen A
(CDC)

Cefotetan 2 g IV q 12 hrs or
Cefoxitin 2 g IV q 6 hours plus
Doxycycline 100 mg IV or PO q 12 hours
(Regimen given for at least 24 hrs after
pt clinically improves. After d/ccontinue Doxycyline 100 mg PO BID x
14 d

In patient

Regimen B
Clindamycin 900 mg IV q 8 hrs plus
Gentamicin LD 2 mg/kg ffd by
maintenance dose 1.5 mg/kg q 8 hrs
(Regimen continued for at least 24 hrs
after pt improves. After discharge, give:
Clinda 450 mg QID x 14 days or
Doxycycline 100 mg BID x 14 days

Criteria for hospitalization

1. Surgical emergencies such as

appendicitis cannot be ruled out.
2. Patient is pregnant.
3. Patient does not respond clinically to
oral antimicrobials
4. Patient unable to follow or tolerate
OPD regiment
5. Patient has severe illness, nausea,
vomiting or high fever

Criteria for hospitalization

6. Patient has tuboovarian abscess

7. Patient is immunocompromised
(HIV with low CD4 counts,
immunosuppressive therapy