Pelvic inflammatory disease: improving awareness, prevention, and treatment

Figures & data

Table 1 PID diagnostic criteria per 2015 CDC guidelines

Minimal clinical criteriaa	Cervical motion tenderness Uterine tenderness Adnexal tenderness
Additional criteriab	Oral temperature greater than 101°F (38.3°C) Abnormal cervical mucopurulent discharge or cervical friability Abundant white blood cells on microscopic evaluation of vaginal fluid Elevated erythrocyte sedimentation rate Elevated C-reactive protein Laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis
Specific criteriac	Endometrial biopsy with histopathologic evidence of endometritis Transvaginal ultrasound or magnetic resonance imaging showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic infection Laparoscopic findings consistent with PID

Notes: Reproduced from CDC. 2015 Sexually Transmitted Diseases Treatment Guidelines. Atlanta, GA: Department of Health and Human Services; 2015.³

a Initiate treatment if one or more of these criteria are met.

b In addition to one or more minimal criteria, one or more of the additional criteria increases specificity of the diagnosis of PID.

c One or more of these criteria provides the most specific diagnosis of PID.

Abbreviations: CDC, US Centers for Disease Control and Prevention; PID, pelvic inflammatory disease.

Table 2 PID antibiotic regimens per 2015 CDC PID treatment guidelines

Parenteral treatmenta
Regimen A	CeFotetan 2 g IV every 12 hours + doxycycline 100 mg PO or IV every 12 hours
Regimen B	CeFoxitin 2 g IV every 6 hours + doxycycline 100 mg PO or IV every 12 hours
Regimen C	Clindamycin 900 mg IV every 8 hours + gentamicin 2 mg/kg loading dose IV or IM followed by 1.5 mg/kg every 8 hours (can substitute single daily dosage of 3–5 mg/kg)
Alternate regimen	Ampicillin/sulbactam 3 g IV every 6 hours + doxycycline 100 mg orally or IV every 12 hours
Oral treatment
Regimen A	CeFtriaxone 250 mg IM in a single dose + doxycycline 100 mg PO BID for 14 days ± metronidazole 500 mg PO BID for 14 days
Regimen B	CeFoxitin 2 g IM and probenecid 1 g PO in a single dose + doxycycline 100 mg PO BID for 14 days ± metronidazole 500 mg PO BID for 14 days
Regimen C	A Third-generation cephalosporin + doxycycline 100 mg PO BID for 14 days ± metronidazole 500 mg PO BID for 14 days

Notes: Reproduced from CDC. 2015 Sexually Transmitted Diseases Treatment Guidelines. Atlanta, GA: Department of Health and Human Services; 2015.³ Trials have shown short-term clinical effectiveness with monotherapy azithromycin 500 mg IV daily for one or two doses +250 mg PO for 5–6 days, or combined with a 12-day course of metronidazole.^67,68

a Continuation of parenteral regimens for 24 hours after clinical improvement then transition to oral regimen to complete the 14-day treatment course.

Abbreviations: BID, twice daily; CDC, US Centers for Disease Control and Prevention; IM, intramuscular; IV, intravenous; PID, pelvic inflammatory disease; PO, by mouth.

CDC2015 Sexually Transmitted Diseases Treatment GuidelinesAtlanta, GADepartment of Health and Human Services2015

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