Pelvic Inflammatory Disease (PID)

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS

Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.


Comments from Expert Advisory Committee

  • PID is usually the result of infection ascending from the endocervix causing endometritis, salpingitis, parametritis, oophoritis, tuboovarian abcess and/or pelvic peritonitis. Occasionally it is caused by local spread within the peritoneal cavity.
  • Chlamydia, gonorrhoea and Mycoplasma genitalium can lead to PID though many cases of PID are negative for these organisms. The presence of other commensal anaerobic genital tract bacteria are believed to be important in facilitating ascent of lower genital tract infections leading to PID.
  • Symptoms vary from mild to severe where hospitalisation and consideration for surgical intervention is required.
  • Mild symptoms include – lower abdominal/pelvic pain, deep dyspareunia, a change in vaginal discharge, post coital bleeding
  • Severe symptoms include – all of the above and in addition there may be constitutional symptoms, shoulder tip pain, right upper quadrant pain (perihepatitis, Fitz-Hugh Curtis Syndrome)
  • In patients presenting with any of the symptoms above it is important to consider the diagnosis of PID and take a sexual history
  • Features on examination include lower abdominal/pelvic tenderness, rebound tenderness, lower abdominal/pelvic mass (in the setting of a tuboovarian abscess), cervical excitation tenderness on bimanual examination
  • All women presenting with symptoms and/or signs suggestive of PID should have a pregnancy test performed
  • All women presenting with symptoms and/or signs suggestive of PID testing for STIs including HIV, Hepatitis B, syphilis, gonorrhoea, chlamydia and Mycoplasma genitalium.
  • HCV testing should be considered part of routine sexual health screening in the following circumstances: People who are HIV positive; Commercial sex workers; PWID; People who inject drugs If indicated by the clinical history e.g. unexplained jaundice; When other risk factors for HCV are present, for example MSM. The full set of recommendations around HCV testing are available in the national HCV screening guidelines
  • Consideration should be given to referring patients with suspected PID to a dedicated STI clinic, sometimes patients will need to be referred to the Emergency Department depending on the severity of symptoms. Patients with positive Mycoplasma genitalium swabs should be referred to a specialist STI clinic for management given the high prevalence of antimicrobial resistance seen in this organism
  • Individuals diagnosed with PID should be advised to abstain from sexual intercourse until treatment completed and where indicated their partner has been treated.
  • Where chlamydia or gonorrhoea have been diagnosed in patients with PID, these infections should be notified. The complete list of notifiable diseases and information on the notification process is available

Treatment

Empiric antibiotic treatment should be directed against chlamydia, gonorrhoea and anaerobic organisms. Outpateint treatment with combination of oral and IM antibiotics is appropriate for the majority of cases.
Admission to hospital and parenteral therapy is indicated in patients unable to tolerate oral therapy, those likely to require surgical intervention (for example tubo ovarian abscess ) and those with evidence of sepsis.
Patients with a positive Mycoplasma genitalium result should be referred to a specialist STI clinic. Please refer to the chlamydia and gonorrhoea pages for further management information

Pelvic Inflammatory Disease treatment table 2019 image


Useful resources

Patient Information

Reviewed December 2018


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