- Treatment must cover gonorrhoea- and chlamydia-associated organisms, as well as anaerobic organisms (especially in severe PID).
- There should always be a low threshold for treatment, even where the diagnosis is not confirmed, as even short delays in treatment of PID will markedly increase the risk of subsequent complications.
- Once pregnancy has been ruled out, mild-to-moderate PID can be managed as outpatients.
- Screening for STIs should be done in cases of suspected PID before starting antibiotics. However, treatment should not be delayed.
- Women with HIV should be given the same antibiotics as those not infected. They should be managed with the help of the HIV physician.
Treatment during pregnancy
Avoid tetracyclines in pregnancy or where there is a possibility of pregnancy. This is owing to their teeth staining properties in the second and third trimesters, as well as skeletal abnormalities in animal studies in the first trimester. PID in pregnancy is rare in the absence of septic miscarriage and the diagnosis should be made after careful consideration.
Treatment in young women
Ofloxacin should be avoided in young women where possible, as bone development is still occurring. Doxycycline can be safely used in children over the age of 12 years.
Where a copper coil or levonorgestrel-releasing intra-uterine system is present with PID, removal is not always necessary. Although better clinical response is seen after removal this must be balanced with the risk of pregnancy, especially where there has been unprotected sexual intercourse in the last seven days. In these cases emergency contraception must be considered.
Coils should be removed when:
- requested by the patient
- there is no response to treatment after 72 hours
- the patient has had actinomyces-like organisms on smear and has pelvic pain.