Speculum examination shows evidence of mucopurulent cervicitis in the majority of pts with gonococcal or chlamydial PID; cervical motion tenderness, uterine fundal tenderness, and/or abnormal adnexal tenderness also is usually present. Vaginal or endocervical swab specimens should be examined by NAATs for N. gonorrhoeae and C. trachomatis.
Treatment: Pelvic Inflammatory Disease - Empirical treatment for PID should be initiated in sexually active young women and in other women who are at risk for PID and who have pelvic or lower abdominal pain with no other explanation as well as cervical motion, uterine, or adnexal tenderness.
- Hospitalization should be considered when (1) the diagnosis is uncertain and surgical emergencies cannot be excluded, (2) the pt is pregnant, (3) pelvic abscess is suspected, (4) severe illness precludes outpatient management, (5) the pt has HIV infection, (6) the pt is unable to follow or tolerate an outpatient regimen, or (7) the pt has failed to respond to outpatient therapy.
- Outpatient regimen: Ceftriaxone (250 mg IM once) plus doxycycline (100 mg PO bid for 14 days) plus metronidazole (500 mg PO bid for 14 days) is effective. Women treated as outpatients should be clinically reevaluated within 72 h.
- Parenteral regimens: Parenteral treatment with the two regimens listed below should be given for ≥48 h after clinical improvement. A 14-day course should be completed with doxycycline (100 mg PO bid); if the clindamycin-containing regimen is used, this drug can be given by the oral route (450 mg PO qid).
- - Cefotetan (2 g IV q12h) or cefoxitin (2 g IV q6h) plus doxycycline (100 mg IV/PO q12h)
- - Clindamycin (900 mg IV q8h) plus gentamicin (loading dose of 2.0 mg/kg IV/IM followed by 1.5 mg/kg q8h)
- Male sex partners should be evaluated and treated empirically for gonorrhea and chlamydial infection.
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