Patient Management/Treatment (continued)

The current CDC recommendations for the treatment of PID include both oral and parenteral regimens.

Oral Regimens

Each of the following oral regimens should be continued for a total of 14 days. Patients on oral therapy ideally should be followed up within 72 hours, at which time they should show substantial clinical improvement. If no improvement occurs, the patient should be re-evaluated to confirm the diagnosis and should be switched to parenteral therapy either in an outpatient or inpatient setting. The addition of metronidazole should be considered, as anaerobic organisms are suspected in the etiology of the majority of cases. Metronidazole will also treat BV, which frequently is associated with PID.

Follow Up

Patients should be re-examined within 72 hours after initiation of therapy and should demonstrate substantial clinical improvement (i.e., defervescence; reduction in rebound or direct abdominal tenderness; reduction in uterine, adnexal, and cervical motion tenderness). Patients who do not improve usually require hospitalization, additional diagnostic tests, and possible surgical intervention.

Some experts recommend rescreening for C. trachomatis and N. gonorrhoeae after therapy, in women with documented infection due to these pathogens. The optimal time period for rescreening is 4-6 weeks.  All women diagnosed with acute PID should be offered HIV testing.

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