PID

Question 1

Is PID reportable?

Answer 1

No

Question 2

What is the rationale for the low diagnostic threshold of PID?

Answer 2

The threshold for diagnosis of PID is low since:

• PID is often unrecognized and untreated
• Diagnosis is difficult
• Potential for damage is high

Question 3

What are common mild and unspecific signs and symptoms of PID (unrelated to diagnosis)?

Answer 3

• Bacterial vaginosis/vaginitis
• Dyspareunia
• Menorrhagia
• Abnormal uterine bleeding

Question 4

What are the diagnostic criteria for PID?

Answer 4

Minimum:
- Lower abdominal pain and/or tenderness
- Cervical motion tenderness with/without mucopus
- Adnexal tenderness

Additional (1 of the following must be present):
- Fever > 100.4F
- Wet mount: WBCs > 10 per hpf (predictive)
- Pelvic mass on exam
- ESR > 15 mm hr
- Positive endocervical culture for:
- N gonorrhea
- C trachomatis

Question 5

What are the criteria for hospitalization for PID?

Answer 5

• No clinical response at 72-hour follow-up
• Unable to follow up
• Cannot exclude surgical emergency
• Pregnancy
• Tubo-ovarian abscess
• Severe nausea or vomiting
• High fever

Question 6

What is the recommended treatment for PID?

Answer 6

Ceftriaxone 250 mg IM (single dose)
–AND–
Doxycycline 100 mg PO BID x 14 days
–AND–
Metronidazole 500 mg PO BID x 14 days

Question 7

Should IUCs be removed in cases of PID?

Answer 7

No, unless there is no improvement within 48 - 72 hours of treatment

Question 8

When should PID patients have follow-up testing?

Answer 8

If chlamydial or gonococcal PID:
- retest 3 months after treatment (regardless of whether partners have been treated)

IMPORTANT NOTE: If 3-month retesting is not possible, retest whenever patient next seeks medical care