Women managed as outpatients should be followed-up at 72 hours. If they do not show significant improvement, they will need hospital referral for further investigations, parenteral antibiotic therapy and/or surgical intervention. A further follow-up should be done at 2–4 weeks to:
- assess response to treatment
- reiterate the importance of screening for STIs
- reassure that if compliance maintained with intake of medications, then fertility is usually maintained. However, there is an increased risk of ectopic pregnancy and chronic pelvic pain. Risk of infertility increases following multiple episodes of PID.
Tests of cure are done if poor compliance, antibiotic resistance or reinfection is suspected.
In women with levonorgestrel-releasing intrauterine system or copper intrauterine device and PID, the coil should be removed if:
- requested by the woman
- there is no response to treatment after 72 hours
- the woman has had actinomyces-like organisms on smear and has pelvic pain.