eMedicine Specialties > Obstetrics and Gynecology > Infections

Salpingitis: Treatment & Medication

Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Coauthor(s): Clarisa R Gracia, MD, Staff Physician, Department of Obstetrics and Gynecology, University of Pennsylvania; Evan M Meiner, MD, Director of Emergency Medicine Trauma Care, Department of Emergency Medicine, North Shore University Hospital; William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
Contributor Information and Disclosures

Updated: Aug 16, 2007

Treatment

Medical Care

From a public health point of view, the goal is to eradicate individual infection and treat potentially infected partners to prevent further spread of STDs. For the individual, the goal of management of salpingitis is to efficiently cure acute infection, thereby preserving fertility and preventing ectopic pregnancy, as well as decreasing the risk of long-term inflammatory sequelae. Early diagnosis and treatment appear to be crucial in the preservation of future fertility. If antibiotic treatment is to prevent complications of disease, it must be initiated early in the disease process. Treatment regimens must include empiric broad-spectrum coverage of all major pathogens, including N gonorrhoeae, C trachomatis, beta-lactamase–producing anaerobes, and facultative organisms, especially group B streptococcus and E coli.

A study from the University of Washington demonstrated that after appropriate antimicrobial therapy, significant decreases occurred in abnormal bleeding (60-29%), mucopurulent cervicitis (20-6%), uterine tenderness (20-6%), and histologic endometritis (38-4%) (all P <.001).

  • Because of the difficulty of diagnosis and the devastating sequelae, even from mild or atypical disease, the CDC has emphasized that physicians should maintain a low threshold for diagnosis and aggressively treat the infection in women if any suspicion of disease exists. Overtreatment is preferable to missed diagnosis.
  • CDC recommendations are based in part on the fact that the diagnosis and management of other common causes of lower abdominal pain (eg, ectopic pregnancy, appendicitis, functional pain) are unlikely to be impaired by initiating empiric antimicrobial treatment for salpingitis. Antibiotics should be begun as soon as the diagnosis is suspected. Paying attention to emerging resistance patterns is important.
  • Since the last CDC recommendations for STDs were published in 2006, clinically significant resistance to the quinolones has developed in Hawaii and the West Coast of the United States, as well as in Asia. In April 2007, the CDC updated treatment guidelines for gonococcal infection and associated conditions. Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC’s Gonococcal Isolate Surveillance Project (GISP). The data from GISP showed the proportion of fluoroquinolone-resistant gonorrhea (QRNG) cases in heterosexual men reached 6.7%, an 11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007 issue of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose).

    Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented. In those patients with severe allergy to cephalosporin, spectinomycin is recommended in Europe and Canada but is currently unavailable in the United States. A 2-g dose of azithromycin may also be used in this group, but azithromycin is not routinely recommended because of concerns regarding rapid development of resistance to this antibiotic. For more information, see the CDC’s Antibiotic-Resistant Gonorrhea Web site; CDC Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues New Treatment Recommendations for Gonorrhea.
  • Unfortunately, at least one small study in an urban teaching hospital suggests poor compliance with all portions of the CDC guidelines.
  • The CDC recommends several parenteral and oral regimens in the Guidelines for Treatment of Sexually Transmitted Diseases. The CDC also has noted that little data exist on long-term outcomes with outpatient treatment. For this reason, the CDC has recommended criteria for hospital admission and intravenous antibiotic treatment. These are based on both observational data and theoretical concerns and include the following:
    • Inability to exclude surgical emergencies, such as appendicitis
    • Pregnant patients
    • Patients who do not respond clinically to an adequate oral antibiotic regimen
    • Patients who are unable to follow or tolerate an outpatient oral regimen
    • Patients who have severe illness, including nausea, vomiting, or high fever
    • Patients with TOA
    • Patients who are immunodeficient (eg, HIV with a decreased CD4 count, taking immunosuppressant drugs, poorly controlled diabetes)
  • Infections that follow placement of an IUD or after operative or diagnostic procedures are best treated in the hospital with IV antibiotics. Obtain large-bore IV access until ectopic pregnancy can be ruled out. Administer IV fluids if the patient is vomiting or dehydrated. Studies have indicated that patients with pelvic infection are not treated for pain adequately on a routine basis, and only a minority of patients receives narcotics. Treat patients with this condition promptly with analgesics. Patients also may require narcotics. Because tubal damage seems to be a result of inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids are theorized to help reduce such damage. At present, studies have revealed no apparent benefit from the addition of these agents.
  • Previous CDC guidelines had included hospitalization for very young patients. The basis for this argument had been that the use of parenteral antibiotics might lead to less scarring and thus preserve fertility and lead to less likelihood of ectopic pregnancy in this group. Recent data have failed to document a difference in outcome in these groups and this recommendation was dropped in the 2002 guidelines. Smith et al performed a feasibility study to determine the economic feasibility of hospitalizing young women with mild to moderate disease.8  Costs per quality adjusted life year (QALY) were calculated under various assumptions regarding the effects of hospitalization on outcomes. If hospitalization decreased PID complications by 10%, 20%, or 30%, costs/QALY were calculated at 145,000, 67,400, and 42,400 respectively. Interventions are considered to have strong evidence for adoption if cost/QALY is less than 20,000, while they are felt to have weak evidence if cost/QALY isgreater than 100,000.

Surgical Care

Laparoscopy is an important diagnostic and therapeutic tool, particularly when the clinical picture is not completely clear. Laparoscopy may not only aid in the diagnosis of salpingitis, but it also is useful in order to exclude other entities such as appendicitis, ovarian torsion, and endometriosis. Findings consistent with salpingitis include inflammation, free pus or purulent fluid in the cul-de-sac or pelvis, and fresh adhesions in the pelvis. In addition, laparoscopy may be therapeutic. Cultures obtained directly from the pelvis can be used to tailor antibiotic therapy. Furthermore, laparoscopic pelvic lavage, drainage of abscesses, and lysis of adhesions may aid in the treatment of this condition.
  • Laparotomy generally is reserved for surgical emergencies, such as ruptured abscesses, or failed medical management of tuboovarian abscesses. Laparotomy also may be used for diagnostic purposes in cases where the patient is not a candidate for laparoscopy.
  • Surgical therapy often is required for cases of salpingitis complicated by TOAs that do not respond to medical management. Persistent or recurrent TOAs require drainage. Percutaneous drainage may be accomplished either via the vagina (posterior colpotomy) or transabdominally using CT or US guidance, depending on the location of the abscess. Patients who are not good candidates for, or fail, percutaneous drainage will require surgical drainage. While reports of successful laparoscopic drainage have been described, the most common method of surgical treatment is laparotomy.
  • Intraoperative findings and the patient's desire for future fertility dictate treatment. If the abscess only involves one tube and ovary, a unilateral salpingo-oophorectomy is performed and the contralateral adnexa and uterus may be conserved. However, often both adnexa and uterus are involved, requiring hysterectomy and bilateral oophorectomy.
  • Chronic inflammation associated with TOAs often results in dense pelvic adhesions, making surgery particularly challenging. Ideally, surgery for recurrent disease should be performed when the acute infection has resolved, ie, the patient is afebrile with a normal white count and a relatively nontender pelvis. Intraabdominal rupture of a TOA is the most life-threatening complication of salpingitis, and treatment requires aggressive resuscitation, IV antibiotics, and emergent laparotomy with removal of free pus, abscesses, and, usually, a total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Consultations

Obtain an OB/GYN consultation if the patient is pregnant, if the diagnosis is unclear, or if the patient fulfills criteria for admission to the hospital. Obtain a general surgery consultation if acute appendicitis or other surgical emergency cannot be excluded.

Diet

Diet does not appear to have an effect on PID.

Smoking was found to be an independent predictor of risk in a recent large multicenter study. The authors hypothesized that smoking might either serve as a marker for poor health seeking behavior or other risky behaviors, or alternatively, might have a biologic effect to compromise immunity or alter estrogen status.

Activity

Women should remain abstinent from sexual activity until they are cured of symptoms and they have completed their full regimen of antibiotics. See Deterrence/Prevention for more information.

Medication

The following regimens are from the 2006 guidelines of the CDC. These regimens have been chosen based on drug studies in appropriately vigorous clinical trials. Emergency medicine physicians are urged to consult any updates in the CDC recommendations because change in sensitivities and epidemiologic concerns will continue to lead to recommended changes in the treatment protocols. Fluoroquinolones are no longer recommended in the United States for gonorrheal infections because of increased resistance.

Parenteral antibiotics

Parenteral regimen A includes cefotetan (Cefotan) or cefoxitin (Mefoxin) plus doxycycline (Doryx, Vibra-Tabs, Vibramycin). Parenteral regimen B includes clindamycin (Cleocin) plus gentamicin (Garamycin). Alternative parenteral regimens include ampicillin/sulbactam (Unasyn) plus doxycycline (Doryx, Vibra-Tabs, Vibramycin). Fluoroquinolone antibiotic are no longer recommended unless parenteral cephalosporins are not feasible, and only if the community prevalence and individual risk of gonorrhea is low.


Cefotetan (Cefotan) or cefoxitin (Mefoxin) plus doxycycline (Doryx, Vibramycin)

Cefotetan and cefoxitin are bactericidal second-generation cephalosporins with some coverage of gram-positive bacteria and very good coverage of gram-negative and anaerobic bacteria. Superior anaerobic coverage to other second- and third-generation cephalosporins.
Doxycycline is a broad-spectrum bacteriostatic antibiotic that inhibits protein synthesis. Some coverage of gram-positive, gram-negative, and anaerobic bacteria, but is used for coverage of C trachomatis. Parenteral therapy is continued until the patient has been clinically improved for 24 h. Continue PO therapy with doxycycline for a complete 2-wk course. When TOA is present, add clindamycin or metronidazole to doxycycline when IV therapy is discontinued and PO therapy is begun. This provides better coverage of anaerobic bacteria than doxycycline alone.

Adult

Cefotetan: 2 g IV q12h or
Cefoxitin: 2 g IV q6h plus
Doxycycline: 100 mg PO/IV q12h

Pediatric

Not established

Cephalosporins: Concomitant use with aminoglycosides can increase risk of nephrotoxicity; disulfiramlike reactions with metronidazole and concomitant alcohol consumption may occur; use with potent loop diuretics or probenecid may increase nephrotoxicity, monitor renal function; cefotetan may increase effects of anticoagulants
Doxycycline: Prolongs PT in patients taking warfarin; antacids, bicarbonate, calcium, and iron supplements decrease its absorption; concomitant use with PO contraceptives may decrease the effectiveness of OCPs; when used in combination with phenytoin or carbamazepine, hepatic metabolism may be induced and doxycycline efficacy may be reduced

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Cephalosporins: Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Doxycycline: May cause photosensitivity, avoid exposure to sunlight or UV radiation; use during tooth development (half way through pregnancy to age 8 y) may cause permanent discoloration of teeth; adjust dosage for decreased renal function and patients with liver disease; may cause severe pain at site of IV infusion; caution in patients with penicillin allergy or renal or hepatic dysfunction


Clindamycin (Cleocin) plus gentamicin (Garamycin)

Clindamycin is a bacteriostatic antibiotic that reversibly inhibits protein synthesis. Good gram-positive coverage (not MRSA or enterococci) and excellent anaerobic coverage but no gram-negative coverage.
Gentamicin is a bactericidal aminoglycoside antibiotic that irreversibly inhibits protein synthesis. Excellent aerobic gram-negative coverage but is not effective against anaerobes.
Single daily dosing may be administered, although single-dose therapy has not been evaluated for the treatment of salpingitis (it has been demonstrated to be effective in similar clinical situations). May discontinue parenteral therapy 24 h after clinical improvement.

Adult

Clindamycin: 900 mg IV q8h plus
Gentamicin: 2 mg/kg IV/IM loading dose, followed by 1.5 mg/kg q8h maintenance
Continued therapy: Doxycycline 100 mg PO bid or clindamycin 450 mg PO qid for 14 d
When TOA is present, clindamycin is preferred as continued therapy rather than doxycycline because it has superior anaerobic coverage

Pediatric

Not established

Clindamycin: Enhances action of nondepolarizing muscle relaxants
Gentamicin: Some cephalosporins, vancomycin, loop diuretics, cisplatin and cyclosporin, and amphotericin B may increase risk of nephrotoxicity or ototoxicity; aminoglycosides potentiate effects of neuromuscular blockers

Documented hypersensitivity; clindamycin is contraindicated in regional enteritis or ulcerative colitis

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Clindamycin: Caution in severe renal disease; reduce dosage in severe liver dysfunction; associated with development of pseudomembranous colitis; may cause elevated LFTs
Gentamicin: Markedly reduced dosage required in patients with decreased renal function, monitor renal function during treatment; can cause nephrotoxicity, ototoxicity, and fever; supplemental dose suggested for patients on dialysis; caution in myasthenia gravis


Ampicillin/sulbactam (Unasyn) plus doxycycline (Doryx, Vibra-Tabs, Vibramycin)

Unasyn is a beta-lactamase–resistant bactericidal semisynthetic penicillin antibiotic that inhibits cell wall biosynthesis. Good coverage against gram-positive, gram-negative, and anaerobic bacteria. Does not cover MRSA, Pseudomonas aeruginosa, or certain resistant nosocomial organisms.
Doxycycline is a broad-spectrum bacteriostatic antibiotic that inhibits protein synthesis. Some coverage of gram-positive, gram-negative, and anaerobic bacteria but is used for coverage of C trachomatis.

Adult

Ampicillin/sulbactam: 3 g IV q6h plus
Doxycycline: 100 mg PO/IV q12h

Pediatric

Not established

Ampicillin/sulbactam: Concomitant use with allopurinol may increase incidence of rash; may decrease the efficacy of OCPs, use backup contraception; probenecid may be used to augment efficacy of ampicillin/sulbactam because it decreases renal excretion and increases concentration of ampicillin
Doxycycline: Prolongs PT in patients taking warfarin; antacids, bicarbonate, calcium, and iron supplements decrease its absorption; concomitant use with PO contraceptives may decrease the effectiveness of OCPs; when used in combination with phenytoin or carbamazepine, hepatic metabolism may be induced and doxycycline efficacy may be reduced

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Ampicillin/sulbactam: Adjust dosage in impaired renal function; caution in patients with allergy to cephalosporin; risk of rash is increased in patients with mononucleosis
Doxycycline: May cause photosensitivity, avoid exposure to sunlight or UV radiation; use during tooth development (half way through pregnancy to age 8 y) may cause permanent discoloration of teeth; adjust dosage for decreased renal function and liver disease; may cause severe pain at site of IV infusion

Oral antibiotics

Outpatient regimen A includes ceftriaxone (Rocephin) IM plus doxycycline PO with or without metronidazole (Flagyl). Outpatient regimen B includes cefoxitin (Mefoxin) plus probenecid or other third-generation cephalosporin plus doxycycline (Doryx, Vibra-Tabs, Vibramycin) with or without metronidazole. Use of fluoroquinolones are no longer recommended in the United States by the FDA because of resistance. Fluoroquinolones may be considered if parenteral cephalosporins therapy is not feasible and if the community prevalence and individual risk for gonorrhea is low. 


Ceftriaxone (Rocephin) or cefoxitin (Mefoxin) plus probenecid plus doxycycline

Ceftriaxone has better coverage against N gonorrhoeae, but cefoxitin has better anaerobic coverage. The optimal choice of cephalosporin for outpatient regimen remains unclear. Theoretically, these regimens have limitations in their anaerobic coverage and may require the addition of metronidazole. Although oral cephalosporins are effective for treatment of cervicitis, no data support their use in treatment of upper tract disease.
Probenecid increases plasma levels of weak organic acids (beta-lactam antibiotics) by completely inhibiting their renal tubular secretion.
Doxycycline is a broad-spectrum bacteriostatic antibiotic that inhibits protein synthesis. Some coverage of gram-positive, gram-negative, and anaerobic bacteria, but is used for coverage of C trachomatis.

Adult

Ceftriaxone: 250 mg IM once or
Cefoxitin: 2 g IM plus
Probenecid: 1 g PO once as a single dose plus
Doxycycline: 100 mg PO bid for 14 d

Pediatric

Not established

Cephalosporins: Concomitant use with aminoglycosides can increase the risk of nephrotoxicity; disulfiramlike reactions with metronidazole and concomitant alcohol consumption may occur; use with potent loop diuretics or probenecid may increase nephrotoxicity, monitor renal function; cefotetan may increase effects of anticoagulants
Probenecid: Increases plasma concentrations of indomethacin, acetaminophen, naproxen, meclofenamate, sulindac, lorazepam, ketoprofen and rifampin; increases the total sulfonamide plasma level and enhances the action of sulfonylureas, leading to a risk of hypoglycemia; enhances the action of thiopental so that less may be required for induction of anesthesia
Doxycycline: Prolongs PT in patients taking warfarin; antacids, bicarbonate, calcium, and iron supplements decrease its absorption; concomitant use with PO contraceptives may decrease the effectiveness of OCPs; when used in combination with phenytoin or carbamazepine, hepatic metabolism may be induced and doxycycline efficacy may be reduced

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Cephalosporins: Adjust dosage in impaired renal function
Doxycycline: May cause photosensitivity, avoid exposure to sunlight or UV radiation; use during tooth development (half way through pregnancy to age 8 y) may cause permanent discoloration of teeth; adjust dosage for decreased renal function and liver disease; may cause severe pain at site of IV infusion

More on Salpingitis

Overview: Salpingitis
Differential Diagnoses & Workup: Salpingitis
Treatment & Medication: Salpingitis
Follow-up: Salpingitis
References
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References

  1. den Hartog JE, Ouburg S, Land JA, Lyons JM, Ito JI, Peña AS. Do host genetic traits in the bacterial sensing system play a role in the development of Chlamydia trachomatis-associated tubal pathology in subfertile women?. BMC Infect Dis. 2006;6:122. [Medline].

  2. Ness RB, Hillier SL, Kip KE, et al. Bacterial vaginosis and risk of pelvic inflammatory disease. Obstet Gynecol. Oct 2004;104(4):761-9. [Medline].

  3. Cherpes TL, Wiesenfeld HC, Melan MA, Kant JA, Cosentino LA, Meyn LA. The associations between pelvic inflammatory disease, Trichomonas vaginalis infection, and positive herpes simplex virus type 2 serology. Sex Transm Dis. Dec 2006;33(12):747-52. [Medline].

  4. Sutton MY, Sternberg M, Zaidi A, St Louis ME, Markowitz LE. Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States, 1985-2001. Sex Transm Dis. Dec 2005;32(12):778-84. [Medline].

  5. Washington AE, Katz P. Cost of and payment source for pelvic inflammatory disease. Trends and projections, 1983 through 2000. JAMA. Nov 13 1991;266(18):2565-9. [Medline].

  6. Mahon BE, Temkit M, Wang J, Rosenman MB, Katz BP. Pelvic inflammatory disease during the post-partum year. Infect Dis Obstet Gynecol. Dec 2005;13(4):191-6. [Medline].

  7. Viberga I, Odlind V, Lazdane G, Kroica J, Berglund L, Olofsson S. Microbiology profile in women with pelvic inflammatory disease in relation to IUD use. Infect Dis Obstet Gynecol. Dec 2005;13(4):183-90. [Medline].

  8. Smith KJ, Ness RB, Roberts MS. Hospitalization for pelvic inflammatory disease: a cost-effectiveness analysis. Sex Transm Dis. Feb 2007;34(2):108-12. [Medline].

  9. Abbuhl S, Shofer F, Reyes I. Pelvic inflammatory disease: Do we treat for pain?. Ann Emerg Med. 1992;21:640.

  10. Abbuhl S, Sternhagen A, Campbell E. Emergency department patients with PID: Do they understand their diagnosis?. Ann Emerg Med. 1989;18:436.

  11. Adams AL, Southwick KL, Jui J, Loveless MO, Kohn MA. Electronic reporting of pelvic inflammatory disease from an emergency department. Sex Transm Dis. Jun 2004;31(6):327-30. [Medline].

  12. Augenbraun M, Bachmann L, Wallace T. Compliance with doxycycline therapy in sexually transmitted diseases clinics. Sex Transm Dis. Jan 1998;25(1):1-4. [Medline].

  13. Blake DR, Fletcher K, Joshi N, Emans SJ. Identification of symptoms that indicate a pelvic examination is necessary to exclude PID in adolescent women. J Pediatr Adolesc Gynecol. Feb 2003;16(1):25-30. [Medline].

  14. Brook I. Microbiology and management of polymicrobial female genital tract infections in adolescents. J Pediatr Adolesc Gynecol. Aug 2002;15(4):217-26. [Medline].

  15. Brook I. The role of beta-lactamase-producing bacteria in obstetrical and gynecological infections. Gynecol Obstet Invest. 1991;32(1):44-50. [Medline].

  16. Bulas DI, Ahlstrom PA, Sivit CJ. Pelvic inflammatory disease in the adolescent: comparison of transabdominal and transvaginal sonographic evaluation. Radiology. May 1992;183(2):435-9. [Medline].

  17. CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline]. [Full Text].

  18. CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline]. [Full Text].

  19. Cohen CR, Mugo NR, Astete SG, Odondo R, Manhart LE, Kiehlbauch JA. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect. Dec 2005;81(6):463-6. [Medline].

  20. Eckert LO, Thwin SS, Hillier SL, Kiviat NB, Eschenbach DA. The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol. Feb 2004;190(2):305-13. [Medline].

  21. Gerbase AC, Rowley JT, Heymann DH. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect. Jun 1998;74 Suppl 1:S12-6. [Medline].

  22. Hadgu A, Westrom L, Brooks CA. Predicting acute pelvic inflammatory disease: a multivariate analysis. Am J Obstet Gynecol. Nov 1986;155(5):954-60. [Medline].

  23. Haggerty CL, Ness RB, Amortegui A, et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol. Jan 2003;188(1):141-8. [Medline].

  24. Haggerty CL, Schulz R, Ness RB, et al. Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease. Obstet Gynecol. Nov 2003;102(5 Pt 1):934-9. [Medline].

  25. Hemsell DL, Nobles BJ, Heard MC. Upper and lower reproductive tract bacteria in 126 women with acute pelvic inflammatory disease. Microbial susceptibility and clinical response to four therapeutic regimens. J Reprod Med. Oct 1988;33(10):799-805. [Medline].

  26. Kane BG, Degutis LC, Sayward HK, D'Onofrio G. Compliance with the Centers for Disease Control and Prevention recommendations for the diagnosis and treatment of sexually transmitted diseases. Acad Emerg Med. Apr 2004;11(4):371-7. [Medline].

  27. Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. Feb 15 1992;146(4):473-81. [Medline].

  28. McCormack WM. Pelvic inflammatory disease. N Engl J Med. Jan 13 1994;330(2):115-9. [Medline].

  29. Miller KE, Ruiz DE, Graves JC. Update on the prevention and treatment of sexually transmitted diseases. Am Fam Physician. May 1 2003;67(9):1915-22. [Medline].

  30. Miller WC. Screening for chlamydial infection: are we doing enough?. Lancet. Feb 5-11 2005;365(9458):456-8. [Medline].

  31. Molander P, Finne P, Sjoberg J, et al. Observer agreement with laparoscopic diagnosis of pelvic inflammatory disease using photographs. Obstet Gynecol. May 2003;101(5 Pt 1):875-80. [Medline].

  32. Mollen CJ, Pletcher JR, Bellah RD, Lavelle JM. Prevalence of tubo-ovarian abscess in adolescents diagnosed with pelvic inflammatory disease in a pediatric emergency department. Pediatr Emerg Care. Sep 2006;22(9):621-5. [Medline].

  33. Morcos R, Frost N, Hnat M. Laparoscopic versus clinical diagnosis of acute pelvic inflammatory disease. J Reprod Med. Jan 1993;38(1):53-6. [Medline].

  34. Mugo NR, Kiehlbauch JA, Nguti R, Meier A, Gichuhi JW, Stamm WE. Effect of human immunodeficiency virus-1 infection on treatment outcome of acute salpingitis. Obstet Gynecol. Apr 2006;107(4):807-12. [Medline].

  35. Ness RB, Keder LM, Soper DE. Oral contraception and the recognition of endometritis. Am J Obstet Gynecol. Mar 1997;176(3):580-5. [Medline].

  36. Ness RB, Kip KE, Hillier SL, Soper DE, Stamm CA, Sweet RL. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. Sep 15 2005;162(6):585-90. [Medline].

  37. Ness RB, Smith KJ, Chang CC, Schisterman EF, Bass DC,. Prediction of pelvic inflammatory disease among young, single, sexually active women. Sex Transm Dis. Mar 2006;33(3):137-42. [Medline].

  38. Padian NS, Washington AE. Pelvic inflammatory disease. A brief overview. Ann Epidemiol. Mar 1994;4(2):128-32. [Medline].

  39. Peipert JF, Boardman L, Hogan JW. Laboratory evaluation of acute upper genital tract infection. Obstet Gynecol. May 1996;87(5 Pt 1):730-6. [Medline].

  40. Peipert JF, Montagno AB, Cooper AS. Bacterial vaginosis as a risk factor for upper genital tract infection. Am J Obstet Gynecol. Nov 1997;177(5):1184-7. [Medline].

  41. Ratelle S, Yokoe D, Blejan C, et al. Predictive value of clinical diagnostic codes for the CDC case definition of pelvic inflammatory disease (PID): implications for surveillance. Sex Transm Dis. Nov 2003;30(11):866-70. [Medline].

  42. Risser WL, Cromwell PF, Bortot AT, Risser JM. Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease. J Pediatr Adolesc Gynecol. Feb 2004;17(1):39-44. [Medline].

  43. Rothman KJ, Funch DP, Alfredson T, et al. Randomized field trial of vaginal douching, pelvic inflammatory disease and pregnancy. Epidemiology. May 2003;14(3):340-8. [Medline].

  44. Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics. Nov-Dec 2002;22(6):1327-34. [Medline].

  45. Sellors JW, Mahony JB, Chernesky MA. Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. Fertil Steril. Mar 1988;49(3):451-7. [Medline].

  46. Shannon C, Brothers LP, Philip NM, Winikoff B. Infection after medical abortion: a review of the literature. Contraception. Sep 2004;70(3):183-90. [Medline].

  47. Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis and pelvic inflammatory disease. J Clin Pathol. Aug 2003;56(8):616-8. [Medline].

  48. Simms I, Warburton F, Weström L. Diagnosis of pelvic inflammatory disease: time for a rethink. Sex Transm Infect. Dec 2003;79(6):491-4. [Medline].

  49. Simpson T, Merchant J, Grimley DM, Oh MK. Vaginal douching among adolescent and young women: more challenges than progress. J Pediatr Adolesc Gynecol. Aug 2004;17(4):249-55. [Medline].

  50. Song AH, Advincula AP. Adolescent chronic pelvic pain. J Pediatr Adolesc Gynecol. Dec 2005;18(6):371-7. [Medline].

  51. Soper DE. Pelvic inflammatory disease. Infect Dis Clin North Am. Dec 1994;8(4):821-40. [Medline].

  52. Sweet RL, Bartlett JG, Hemsell DL, Solomkin JS, Tally F. Evaluation of new anti-infective drugs for the treatment of acute pelvic inflammatory disease. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis. Nov 1992;15 Suppl 1:S53-61. [Medline].

  53. Sweet RL, Schachter J, Landers DV. Treatment of hospitalized patients with acute pelvic inflammatory disease: comparison of cefotetan plus doxycycline and cefoxitin plus doxycycline. Am J Obstet Gynecol. Mar 1988;158(3 Pt 2):736-41. [Medline].

  54. Trent M, Judy SL, Ellen JM, Walker A. Use of an institutional intervention to improve quality of care for adolescents treated in pediatric ambulatory settings for pelvic inflammatory disease. J Adolesc Health. Jul 2006;39(1):50-6. [Medline].

  55. Washington AE, Cates W, Wasserheit JN. Preventing pelvic inflammatory disease. JAMA. Nov 13 1991;266(18):2574-80. [Medline].

  56. Yealy DM, Greene TJ, Hobbs GD. Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in the emergency department. Acad Emerg Med. Oct 1997;4(10):962-7. [Medline].

  57. Yudin MH, Hillier SL, Wiesenfeld HC, et al. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol. Feb 2003;188(2):318-23. [Medline].

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Further Reading

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Keywords

salpingitis, pelvic inflammatory disease, PID, pelvic inflammation, oviduct inflammation, oviduct infection, gynecologic infection, fallopian tube inflammation, fallopian tube infection, tuboovarian abscess, TOA, tubo-ovarian abscess, infertility, Neisseria gonorrhoeae, N gonorrhoeae, C trachomatis, Chlamydia trachomatis, Bacteroides, Peptostreptococcus, Peptococcus, gonorrhea, chlamydia, sexually transmitted disease, STD complication, STD

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Contributor Information and Disclosures

Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Clarisa R Gracia, MD, Staff Physician, Department of Obstetrics and Gynecology, University of Pennsylvania
Clarisa R Gracia, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, and American Society for Reproductive Medicine
Disclosure: Nothing to disclose.

Evan M Meiner, MD, Director of Emergency Medicine Trauma Care, Department of Emergency Medicine, North Shore University Hospital
Evan M Meiner, MD is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Glaxo Smith Kline Consulting fee Consulting; Glaxo Smith Kline Honoraria Speaking and teaching

Medical Editor

Bruce A Meyer, MD, MBA, Vice President for Medical Affairs, Associate Dean for Health System Affairs and Director of the Faculty Practice Plan, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School
Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gail F Whitman-Elia, MD, Professor, Department of Obstetrics and Gynecology, University of South Carolina School of Medicine
Gail F Whitman-Elia, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Clinical Endocrinologists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, American Medical Women's Association, American Public Health Association, American Society for Reproductive Medicine, Endocrine Society, and South Carolina Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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