Pelvic Inflammatory Disease Response

With the diagnosis of pelvic inflammatory disease, it is essential to begin treatment promptly and effectively early in order to prevent any complications or damage to the female reproductive organs.  According to Huether et al. (2020), the pelvic inflammatory disease diagnosis should be considered by clinicians in all patients who are sexually active and are exhibiting symptoms including pelvic tenderness and one of the following: cervical motion tenderness, uterine tenderness, or adnexal tenderness.  Brun et al. (2016) discussed diagnostic tools and criteria for the diagnosis of pelvic inflammatory disease.  It was reported that a complete blood count and a C-reactive assay should be completed but does not rule out uncomplicated pelvic inflammatory disease.  The authors also discuss the use of pelvic ultrasonography for diagnosis of pelvic inflammatory disease as well as the potential for any tubo-ovarian abscess.  If imaging is not sufficient for diagnosis, further testing could include a CT scan or an MRI as well as the use of an endometrial biopsy.  In addition, Brun et al. (2016) state that for diagnosis of microorganisms, a vaginal sample should be obtained firstly and then an endocervical sample should be obtained.

Treatment should be started immediately even before diagnostic testing is completed in order to prevent damage to reproductive organs.  Huether et al. (2020) report that preliminary treatment needs to be effective against a broad range of microorganisms due to diagnostic test results not being available immediately.  According to the Centers for Disease Control and Prevention (2015), the majority of patients who have pelvic inflammatory disease can be treated on an outpatient level of care with the exception of those with advanced disease or are at high-risk.  High-risk patients include advanced disease, co-morbidities, pregnancy, or the patient cannot take oral medications.  The therapeutic regimen prescribed should be effective against Gonorrhea and Chlamydia because these organisms have been seen as infecting the upper reproductive tract even when the endocervical swab returns with negative results.  In addition, it would be beneficial to have a therapeutic regimen effective against anaerobic microorganisms (Centers for Disease Control and Prevention, 2015).

Current CDC guidelines for the treatment of pelvic inflammatory disease depends on the severity of the disease.  For oral and intramuscular regiments, the usual recommended treatment consists of a combination of medications that may include ceftriaxone, doxycycline, metronidazole, cefoxitin, probenecid, or a cephalosphorin.  If a patient’s symptoms have not improved within seventy two hours, further diagnostic testing should be completed to rule out a different diagnosis or the need for intravenous pharmacologic treatment.  If there is advanced disease or if there is a high risk for complications, the clinician should determine if an inpatient level of care is needed to administer intravenous pharmacological treatment.  In addition, the Centers for Disease Control and Prevention (2015) also recommends that the female patient abstain from sexual intercourse and activities until infection has subsided.  The patient should also make her sexual partners aware, so they may also seek treatment for any potential infections, before sexual activity occurs again (Centers for Disease Control and Prevention, 2015).

Safrai et al. (2020) recently completed a study to determine the risk factors associated with recurrent pelvic inflammatory disease.  Their research participants included a total of one hundred and thirty three women who have had pelvic inflammatory disease.  Within this sample, thirty three of the participants had recurrent pelvic inflammatory disease.  Safrai et al. (2020) determined that risk factors for recurrent pelvic inflammatory disease included the previous history of pelvic surgeries, the insertion of an intrauterine device, and the pharmacologic treatment of a combination of gentamicin and clindamycin.  Those who were treated with Augmentin had a decreased recurrence of pelvic inflammatory disease.  In addition, Safrai et al. (2020) concluded that those who had recurrent disease, would often require increasingly more invasive treatment due to worsening of reproductive tract.

References

Brun, J., Graesslin, O., Fauconnier, A., Verdon, R., Agostini, A., Bourret, A., Derniaux, E.,

Garbin, O., Huchon, C., Lamy, C., Quentin, R., & Judlin, P. (2016). Updated French

guidelines for diagnosis and management of pelvic inflammatory disease. International

            Journal of Gynecology & Obstetrics, 134(2), 121-125.

https://doi-org.wilkes.idm.oclc.org/10.1016/j.ijgo.2015.11.028

Centers for Disease Control and Prevention. (2015). Pelvic inflammatory disease. U.S.

Department of Health and Human Services. https://www.cdc.gov/std/tg2015/pid.htm

Huether, S.E., McCance, K.L., & Brashers, V.L. (2020). Understanding Pathophysiology.

Elsevier.