Treatment Practices of Pelvic Inflammatory Disease at Selected STD Clinics: STD Surveillance Network, 2015–2017 [16R

Abstract

INTRODUCTION: CDC recommends broad-spectrum antimicrobial therapy (ceftriaxone 250 mg and doxycycline 100 mg BID for 14 days) for women with mild to moderate acute pelvic inflammatory disease (PID). The addition of metronidazole, commonly used to treat bacterial vaginosis (BV) and trichomoniasis, can be considered. We assessed PID treatment practices in STD clinic settings. METHODS: We conducted a cross-sectional analysis of women diagnosed with PID from 2015-2017 in 26 U.S. STD clinics. For each PID episode, we reviewed treatment information within 14 days of the visit where PID was diagnosed, stratified by concomitant diagnosis of BV and/or trichomoniasis. RESULTS: A total of 1,032 PID episodes were identified over 3 years. Treatment was documented in 941 (91.2%) episodes. Of these 941 episodes, concomitant BV and/or trichomoniasis was identified in 40.0% (377/941) of episodes (31.9% BV only, 5.2% trichomoniasis only, and 3.0% both BV and trichomoniasis). CDC recommended therapy was documented for 66.7% of all PID episodes; an additional 25.7% received ceftriaxone with dosing for doxycycline <14 days. Metronidazole, in combination with PID treatment, was documented in 52.5% of episodes. Metronidazole was more frequently included in episodes associated with BV and/or trichomoniasis (72% [271/377]) compared to those without these diagnoses (39% [220/564]). CONCLUSION: Over 90% of patients diagnosed with PID in selected STD clinics were treated with the recommended ceftriaxone; however, over a quarter did not receive the recommended dose of doxycycline. Metronidazole was provided in about half of PID episodes and was more likely to be included with concurrent BV and/or trichomoniasis.