eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology
Pelvic Inflammatory Disease: Follow-up
Updated: Feb 4, 2009
Follow-up
Further Inpatient Care
- Clinical improvement should occur within 3 days of initiating therapy.
- Consider further diagnostic tests, laparoscopy, or both if symptoms do not improve or worsen.
- Surgical intervention may be indicated in patients with an enlarging pelvic mass despite medical therapy, intraperitoneal bleeding secondary to erosion into a vessel, or abscess rupture.
- Remove IUDs following institution of antibiotics.
Further Outpatient Care
- Patients should continue oral antibiotics for a full 2 weeks.
- Follow-up is suggested in 3 days to monitor clinical improvement.
- Sexual abstinence is advised until cure is achieved.
- Treatment of sexual contacts is essential to prevent reinfection.
- The CDC recommends the treatment of partners who have had sex with the patient during the 60 days preceding onset of symptoms.
Transfer
- Transfer is advised only if a patient is stable and only if the hospital is incapable of managing acutely ill patients with gynecological emergencies.
Deterrence/Prevention
- All patients should routinely receive sexual counseling, including advice to practice safe sex with the use of condoms. Other areas of discussion include limiting the number of sexual partners and avoiding contact with high-risk partners. Adolescents should be advised to delay the onset of sexual activity until the age of 16 years or older, as they are at an increased risk for pelvic inflammatory disease.
- Barrier contraceptives (eg, diaphragms with spermicidal agents) and oral contraceptives are thought to reduce the risk for developing pelvic inflammatory disease.
- Intrauterine devices (IUDs) predispose patients to pelvic inflammatory disease, predominantly during the first few months after insertion.
- Frequent vaginal douching was considered to be a risk factor for pelvic inflammatory disease, but recent studies reveal no clear association.4
Complications
- Ectopic pregnancy is 6 times more likely in women who have had pelvic inflammatory disease than in those who have not.
- Tubal damage and scarring can result in infertility. One study demonstrated infertility in 8% of women after a single episode of pelvic inflammatory disease and in 40% of women after 3 or more episodes.
- One investigator found chronic pelvic pain in up to 18% of women after pelvic inflammatory disease had resolved.
Prognosis
- The prognosis is good if diagnosed and treated early.
- A poor prognosis is related to late therapy and continued unsafe lifestyle.
Patient Education
- Emergency physicians should emphasize behavioral and contraceptive methods to prevent the acquisition of sexually transmitted diseases (STDs).
- HIV testing should be recommended.
- Patients must be encouraged to complete the recommended antibiotic treatment for the full 14 days.
- Sexual partners of patients diagnosed with pelvic inflammatory disease must be treated to prevent reinfection.
- For excellent patient education resources, visit eMedicine's Women's Health Center, Sexually Transmitted Diseases Center, and Pregnancy and Reproduction Center. Also, see eMedicine's patient education articles Pelvic Inflammatory Disease, Birth Control Overview, Birth Control FAQs, and Female Sexual Problems.
Miscellaneous
Medicolegal Pitfalls
- Failure to diagnose and treat patients with pelvic inflammatory disease (PID) in a timely manner
- Failure to test for pregnancy and potentially to misdiagnose ectopic pregnancy
- Failure to obtain a medication allergy history
- Failure to test for syphilis
- Failure to advise that sexual partners must be treated
More on Pelvic Inflammatory Disease |
| Overview: Pelvic Inflammatory Disease |
| Differential Diagnoses & Workup: Pelvic Inflammatory Disease |
| Treatment & Medication: Pelvic Inflammatory Disease |
 Follow-up: Pelvic Inflammatory Disease |
| References |
| « Previous Page |
References
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CDC. Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep. May 10 2002;51(RR-6):1-78. [Medline].
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. April 13 2007;56(14):332-336.
Ness RB, Hillier SL, Kip KE, et al. Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women. Am J Epidemiol. Jan 15 2005;161(2):186-95. [Medline].
CDC. 1998 guidelines for treatment of sexually transmitted diseases. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. Jan 23 1998;47(RR-1):1-111. [Medline].
FDA. Center for Drug Evaluation and Research. Drugs to be discontinued. Available at www.fda.gov/cder/drug/shortages/#disc. Accessed May 2, 2007.
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Ness RB, Trautmann G, Richter HE, et al. Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial. Obstet Gynecol. Sep 2005;106(3):573-80. [Medline].
Rice R, Schwartz D, Knapp J, et al. Pelvic inflammatory disease. In: Morse, Moreland, Holmes, eds. Atlas of Sexually Transmitted Diseases and AIDS. 1996:134-47.
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].
Soper DE. Pelvic inflammatory disease. Infect Dis Clin North Am. Dec 1994;8(4):821-40. [Medline].
Suss AL, Homel P, Hammerschlag M, Bromberg K. Risk factors for pelvic inflammatory disease in inner-city adolescents. Sex Transm Dis. May 2000;27(5):289-91. [Medline].
Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. Apr 1 2007;44 Suppl 3:S111-22. [Medline].
Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. A cohort study of 1,844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis. Jul-Aug 1992;19(4):185-92. [Medline].
Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL. Comparison of acute and subclinical pelvic inflammatory disease. Sex Transm Dis. Jul 2005;32(7):400-5. [Medline].
Further Reading
Keywords
pelvic inflammatory disease, PID, infertility, infections of female upper genital tract, endometritis, tuboovarian abscess, peritonitis, Chlamydia trachomatis, C trachomatis, Neisseria gonorrhoeae, N gonorrhoeae, Peptococcus, Peptostreptococcus species, Bacteroides species, genital Mycoplasma, Ureaplasma species, gut coliforms, chronic pelvic pain, vaginal discharge, low back pain, irregular vaginal bleeding, gonococcal PID, mucopurulent cervical discharge, uterine tenderness, adnexaltenderness, sexually transmitted disease, STD, Gardnerella vaginalis, Streptococcus agalactiae, Haemophilus influenzae, Haemophilus parainfluenzae, Actinomyces species, granulomatous salpingitis, Mycobacterium tuberculosis, Schistosoma species
