Management Of Pelvic Inflammatory Disease Research Articles

Evolving trends in the management of pelvic inflammatory disease (PID) during SARS-CoV-2 pandemic: A multicenter retrospective cohort study.

Pelvic inflammatory disease (PID) is usually managed by conservative treatment, but in selected cases, especially in the presence of a tubo-ovarian abscess (TOA), surgical management is a recognized treatment option. We compared the trends in managing PID and short-term outcomes before and during the SARS-CoV-2 pandemic. This is a retrospective study performed in three Italian gynecological centers. We included patients admitted to hospital with a diagnosis of PID. Demographic characteristics, management, time to diagnosis, and time to treatment were compared before versus during the SARS-CoV-2 pandemic. One hundred nineteen PID patients were screened, eighty-one before the SARS-CoV-2 pandemic, and thirty-eight after the onset. At admission, leukocytosis (median 19.73 vs. 13.99 WBC/mm3, p-value = 0.02) was significantly higher in patients who underwent surgery after the onset of the pandemic. TOA incidence was higher in patients who underwent surgery during the SARS-CoV-2 pandemic, but the difference did not reach statistically significance (p = 0.06). The proportion of patients treated with surgery dropped to 26.3% after the onset from 46% of patients before the onset of pandemic (p = 0.03). Furthermore, a higher percentage of emergency surgical procedures on day 0 of hospital admission were performed after the onset of the pandemic (50% vs. 13.1%, p = 0.01). In this retrospective cohort study, we found that the SARS-CoV-2 pandemic influenced the clinical presentation and management of PID in favor of conservative treatment. Patients who underwent surgery during the SARS-CoV-2 pandemic had higher inflammatory markers.

Management of pelvic inflammatory disease with individualised homoeopathic medicine Natrum muriaticum in LM potency: A case report

Management of pelvic inflammatory disease with individualised homoeopathic medicine Natrum muriaticum in LM potency: A case report

Management of Pelvic Inflammatory Disease in Clinical Practice.

Pelvic inflammatory disease (PID) is a common reproductive health disorder among women of reproductive age. The treatment of PID has slowly evolved, reflecting changing antibiotic susceptibility and advancements in therapeutics and research; however, it has been largely unchanged over the last several decades. The most recent treatment recommendations consider the severity of infection, clinical presentation, and the polymicrobial nature of the disease. In addition, the role of novel organisms like Mycoplasma genitalium in PID is of emerging significance. PID treatment guidance offers oral and parenteral treatment options based on the patient's clinical status; however, deviations from the published guidelines are a general concern. Point of care (POC) testing for precision care, provision of adherence support, optimizing self-management and prevention strategies, and other alternative or synergistic approaches that maximize treatment outcomes will be instrumental for addressing the current challenges in PID diagnosis and management.

Pelvic inflammatory disease and causative pathogens in older women in a medical center in eastern Taiwan: A retrospective cross-sectional study.

ObjectivesMost research into the management of pelvic inflammatory disease (PID) is in younger women and focuses on sexually transmitted pathogens such as N. gonorrhoeae or C. trachomatis. Non-sexually transmitted bacterial pathogens and PID in older women are rarely examined. The objective of this study is to explore cervical culture pathogens in women of different age groups in a medical center in eastern Taiwan.MethodsWe enrolled patients whose medical records were diagnosed with PID (ICD-9-CM 614.0 [N70.01–03], 614.1[N70.11–13], 614.9 [N73.5, N73.9]) at our hospital from October 2014 to March 2020. Patients were divided into three groups according to age: the age <25 years, age 25–44 years, and the ≥ 45 years group. Chi-square test, ANOVA and logistic regression were used for statistical analysis. In subgroup analysis, endocervical pathogens were further stratified into vaginal, respiratory, enteric, skin, oral, and other.ResultsA total of 96 patients were included in the study. There were 31 patients in the age ≥ 45 years group, 52 patients in the age 25–44 years group, and 13 patients in the age <25 years group. Vagina and enteric pathogens were the most common pathogens among all groups. The isolated respiratory and other pathogens were more in the age ≥ 45 years group than in the other two groups. Prevotella bivia was more common in the age <25 years and 25–44 years groups.ConclusionsThis may be due to different pathogeneses of PID in the age ≥ 45 years patients. Our study can be used as a reference for antibiotic choice of non-sexually transmitted PID and to prevent long-term sequelae of PID.

Pelvic Inflammatory Disease (PID) Management in Corona Virus Disease 2019 (COVID-19) Era

Objective: This article aims to review pelvic inflammatory disease management during the coronavirus disease 2019 pandemic Method: We conducted a search for scientific articles through PubMed and Google Scholar, using the terminologies of “PID AND COVID-19”, “Pelvic Inflammatory Disease”; “Pelvic Inflammatory Disease AND COVID-19”, “PID Management AND COVID-19”, “Pelvic Inflammatory Disease Management AND COVID-19”, and “PID AND Pandemic” in English and Indonesian from 2019-2020. Result: There were a total of 25 scientific articles from PubMed and Google Scholar within 2019-2020 that were included as the source of this review Conclusion: There is no difference between the management of pelvic inflammatory disease during and before the pandemic. The mode of medical services and follow up tends to be conducted virtually. Technology-based services for pelvic inflammatory disease during the corona virus disease 2019 pandemic are promising and have been proven to be an effective method, therefore virtual-based pelvic inflammatory disease services may be safely applied. However, if there is any indication of emergency found during the telemedicine services, a face-to-face consultation or emergency room visit should be recommended. Key words : COVID-19, Pelvic Inflammatory Disease, SARS-CoV-2

Value of serum procalcitonin as an early predictor of antibiotic treatment response in inpatients with pelvic inflammatory disease (VALID)

ObjectiveThis study aimed to investigate the value of serum procalcitonin as an early predictor of antibiotic treatment response in the inpatient management of pelvic inflammatory disease (PID). Materials and methodsA prospective observational study was carried out at a university hospital. Patients admitted for pelvic inflammatory disease were classified into 2 groups: responders and non-responders. The primary outcome measure was the serum level of procalcitonin at the time of admission. The secondary outcome measures were other serum inflammatory markers including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. ResultsBaseline characteristics were similar between the groups. Serum level of procalcitonin at the time of admission did not differ between the groups (P = 0.564). However, the non-responders had more elevated CRP and ESR compared to the responders (P = 0.045 and P = 0.030, respectively). CRP showed the highest accuracy of 72.1% (95% confidence interval [CI], 59.2 to 82.9) in predicting antibiotics response, while procalcitonin showed the lowest accuracy of 49.1% (95% CI, 35.1 to 63.2). ConclusionCompared with standard inflammatory markers such as CRP or ESR, procalcitonin had limited diagnostic value in predicting antibiotics response in patients admitted for PID. Therefore, procalcitonin measurement cannot be recommended as a laboratory test for patients with PID and the value of its routine use remains inconclusive.

Benefits of second-look laparoscopy in the management of pelvic inflammatory disease

ObjectiveTo evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID). Study designA 5- year retrospective study conducted at Clermont-Ferrand University Hospital and included all patients who had undergone SLL following a PID. Data collection comprised patient and disease characteristics, type of initial medical or surgical treatment, adhesion (AFS) and tubal (MAGE) scores recorded during SLL and outcomes following subsequent pregnancies. Results76 patients who had received SLL were included. A higher rate of severe adhesions was recorded during SLL in patients with stage 3 PID, than for women with stage 1 and 2 (63.6% versus 25%, p = 0.01). A higher rate of Mage scores of 4 were also found in patients with stage 3 PID (25.8% versus 0%, p = 0.001). Multivariate analysis revealed that women at stage 3 are 17 times more likely to have a high level of adhesions than patients at stage 1 (OR [95% CI] = 17.4 [1.7; 1]). A Mage score of 1was found to be associated with higher pregnancy and live birth rates. Conclusion(s)SLL seems presents benefits for the preservation of fertility in cases of severe PID with tubo ovarian abcess and may be proposed to patients with stage 3 salpingitis and desire for pregnancy. Further prospective randomized study should be done to confirm these results.

2017 European guideline for the management of pelvic inflammatory disease.

The European guideline for the management of pelvic inflammatory disease includes evidence-based advice on the investigation and treatment of pelvic inflammatory disease (PID). It has been updated to acknowledge the role of Mycoplasma genitalium as an important cause of PID with testing now recommended for women presenting with possible PID and for the male partners of women with confirmed M. genitalium infection. Recent evidence suggests that serious adverse events are uncommon when using moxifloxacin and its use is now recommended as a first-line therapy, especially in those women with M. genitalium PID. The potential utility of MRI scanning of the pelvis in excluding differential diagnoses has been highlighted. The use of doxycycline is now suggested as empirical treatment for male partners of women with PID to reduce exposure to macrolide antibiotics, which has been associated with increased resistance in M. genitalium.

P140 A need to reinforce the importance of pregnancy testing and correct antibiotic regimen: a re-audit of pid management against bashh guidelines

IntroductionBASHH guidelines (2011) for the management of pelvic inflammatory disease (PID) recommend one of two antibiotic regimens for outpatient treatment. In addition, patients should be offered a pregnancy test and full screening for sexually transmitted infections (STI).Aim(s)/objectivesTo review PID management across the sexual health clinics, comparing it to the previous year’s audit and BASHH guidelines.MethodsData was retrospectively collected from December 2015 until March 2016. Data collected included whether pregnancy was excluded, STI screening, antibiotic regimen used, provision of written information, partner notification, and outcome at any follow up.Results51 patients were identified, 2 were excluded due to treatment by their GP. 100% of cases had at least one sign or symptom suggestive of PID. 47/49 (96%) of cases had STI screening; 41/49 (84%) had a HIV screen as part of this. Pregnancy was excluded in 22/49 (45%) of cases. A BASHH recommended antibiotic regimen was used in 28/49 (57%) of cases. Of the 21 of non-compliant cases, only 4/21 had a documented allergy or intolerance that precluded standard treatment.DiscussionSince the last audit, recommended antibiotic treatment for PID has improved, but remains low at 57%. Pregnancy exclusion was low at 45%, compared with 70% at the last audit. Differences in how healthcare professionals record information on the electronic system could partially account for this. Actions have been taken to improve treatment and pregnancy testing by giving individual feedback to the clinicians, with a re-audit planned to assess the outcome of these interventions.

P078 Closing the audit cycle in the management of Pelvic Inflammatory Disease (PID): updating Trust guidelines leads to a huge improvement in PID treatment

Background Correct management of Pelvic Inflammatory Disease (PID) is important to reduce complications but often varies widely. An audit of PID management in our trust’s GUM clinics was undertaken in 2014 which led to trust guidelines being updated in early 2015. The main finding was antibiotic regimes were varied; only 12% received a BASHH recommended regime. We re-audited the management of PID in 2015. Aim To compare PID management across our trust’s GUM clinics in 2014 and 2015. Methods Electronic patient records of 141 female patients with C5A codes in 2014 and 100 in 2015 were reviewed and compared. Results In both audits 98% of patients had Chlamydia/Gonorrhoea NAATs sent; 93% had vaginal microscopy in 2014 and 92% in 2015, but cervical microscopy improved from 13% in 2014 to 45% in 2015. Pregnancy tests were inconsistently done, 83% in 2014 and 75% in 2015. Those with chlamydia, gonorrhoea or trichomonas vaginalis increased from 8% to 13% but bacterial vaginosis was the most common finding, 28% in 2014 and 46% in 2015. Antibiotic regimes were BASHH recommended in 12% (2014) and 88% (2015), due to updated 2015 trust guidelines being in line with BASHH. Discussion Improvements have occurred since 2014 but cervical microscopy and pregnancy tests are still not consistently being done. Low levels of STIs detected may represent incorrect diagnosis in some. Antibiotic prescription has improved significantly, however we are still below the BASHH target of 95% (currently 88% compliance). We will re-present findings of this re-audit to clinics to improve standardisation of PID management.

Management of Pelvic Inflammatory Disease in Selected U.S. Sexually Transmitted Disease Clinics: Sexually Transmitted Disease Surveillance Network, January 2010-December 2011.

Pelvic inflammatory disease (PID) remains an important source of preventable reproductive morbidity, but no recent studies have singularly focused on US sexually transmitted disease (STD) clinics in relationship to established guidelines for diagnosis and treatment. Of the 83,076 female patients seen in 14 STD clinics participating in the STD Surveillance Network, 1080 (1.3%) were diagnosed as having PID from 2010 to 2011. A random sample of 219 (20%) women were selected, and medical records were reviewed for clinical history, examination findings, treatment, and diagnostic testing. Our primary outcomes were to evaluate how well PID diagnosis and treatment practices in STD clinic settings follow the Centers for Disease Control and Prevention (CDC) treatment guidelines and to describe age group-specific rates of laboratory-confirmed Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in patients clinically diagnosed as having PID in the last 12 months, inclusive of the PID visit. Among the 219 women, 70.3% of the cases met the CDC treatment case definition for PID, 90.4% had testing for CT and GC on the PID visit, and 68.0% were treated with a CDC-recommended outpatient regimen. In the last 12 months, 95.4% were tested for CT or GC, and positivity for either organism was 43.9% in women aged 25 years or younger with PID, compared with 19.4% of women older than 25 years with PID. Compliance with CDC guidelines was documented for many of the women with PID, though not all. Our findings underscore the need for continued efforts to optimize quality of care and adherence to current guidance for PID management given the anticipated expertise of providers in these settings.

Enfermedad inflamatoria pélvica: tratamiento médico y quirúrgico

Un punto crucial en el manejo de la enfermedad inflamatoria pélvica (EIP) es determinar el tipo de tratamiento más adecuado en cada caso. El tratamiento inicial usualmente es ambulatorio; pero, dependiendo de la severidad, se requerirá de hospitalización. Teniendo en cuenta la naturaleza polimicrobiana de esta entidad, la terapia antibiótica debe ser de amplio espectro y la elección de los antibióticos debe estar dirigida a los gérmenes más frecuentes. El tratamiento no solo debe erradicar el cuadro agudo, sino prevenir sus complicaciones, tales como dolor pélvico crónico, infertilidad y embarazo ectópico, las cuales pueden no presentarse o ser minimizadas si se realiza un tratamiento precoz, agresivo y de cobertura amplia. La enfermedad inflamatoria pélvica tiene en el absceso tuboovárico y el absceso pélvico sus formas de presentación más severas. El tratamiento de estas patologías ha variado en el tiempo, desde una conducta muy radical antes de le era preantibiótica hasta una conducta más conservadora, con la finalidad de preservar los órganos reproductores. Esta revisión tiene por objetivo presentar los diferentes esquemas de tratamiento antibiótico actuales para el manejo de la EIP, así como las diferentes alternativas de tratamiento quirúrgico, para los casos de abscesos pélvicos.

P167 Weekly case review and telephone follow up to improve management of pelvic inflammatory disease (PID) in a sexual health clinic

Introduction Previous audits of our management of Pelvic Inflammatory Disease (PID) have shown poor compliance with guidelines, including missing pregnancy testing (PT) in 47% and no follow up in 66%. Aims To improve management and follow up of PID. Methods We introduced a weekly notes review of all PID cases attending our sexual health service. Clinicians received feedback about incorrect antibiotics, or failing to do pregnancy testing (PT). An unsolicited phone call was made to patients not attending 2 week review, to discuss symptoms, treatment completion, partner treatment and abstinence. This is a review 4 months September–December 2014. Results 101 patients were treated for PID. 25% did not have a PT documented,. Overall 46% received recommended antibiotics (30% in the first 2 months, 64% in the last 2 months). 29% attended for review. Phone calls reached 28% of the remaining patients. 90% of patients contacted or attending had completed treatment. 53% still had symptoms Discussion Weekly review allowed for regular feedback to clinicians about documentation and management. Pregnancy testing rates were improved on previous results, though still of concern. Antibiotic prescribing was initially poor, probably due to a recent change in protocol. This improved over the course of the 4 months, suggesting the value of weekly targeted feedback. Unfortunately, phone calls were often unsuccessful, though patients were happy to receive calls. A significant number of patients still had symptoms, undermining our previous assumption of cure where patients failed to attend follow up. To improve telephone follow up, pre-arranged times or methods of contact may be worth trialling.

P126 The 2014/15 european collaborative clinical group (ECCG) service evaluation on the management of pelvic inflammatory disease

<h3>Background</h3> Pelvic Inflammatory Disease (PID) describes a broad spectrum of disease primarily diagnosed clinically, with signs and symptoms lacking both specificity and sensitivity. Mycoplasma genitalium (MG) is being increasingly implicated in cases of non-chlamydial non-gonococcal PID. The core principle of the management of PID remains to maintain a low threshold for diagnosis and treatment to prevent long-term sequelae. <h3>Aim</h3> To evaluate the current management of PID amongst sexual health physicians across Europe against the current European guidelines. <h3>Methods</h3> A clinical scenario based questionnaire was developed by a panel of European experts on PID, and this was disseminated to a group of 120 sexual health physicians across 38 countries who are members of the European Collaborative Clinical Group (ECCG) – a network of sexual health specialists who conduct questionnaire based research across the European region. <h3>Results</h3> Provisional results demonstrate variation in practice across Europe and this is most marked in routine testing for and treatment of MG-associated PID, factors influencing the choice of antibiotic therapy, and action taken when an intrauterine device or system is <i>in situ</i>. Full results will be available by the conference. <h3>Conclusion</h3> The management of PID varies across Europe and is not always in line with current European guidelines. There is a need for ongoing Europe wide education to ensure that patients are receiving evidence based care. Furthermore, there are issues in clinical practice which are currently not covered by the European guidelines and these need to be reviewed to provide physicians with appropriate guidance.

P147 A trust-wide audit on pelvic inflammatory disease management in a genitourinary medicine setting

<h3>Abstract</h3> SARS-CoV-2 is the causative agent of worldwide pandemic disease COVID-19. SARS-CoV-2 bears positive sense RNA genome, that have organized and complex pattern of replication/transcription process including the generation of subgenomic RNAs. Transcription regulatory sequences (TRS) have important role in the pausing of replication/transcription and generation of subgenomic RNAs. In the present bioinformatics analysis a consensus secondary structure was identified among negative sense subgenomic RNAs at the adjacent of initiation codon. This study proposed that consensus structured domain could involve in mediating the long pausing of replication/transcription complex and responsible for subgenomic RNA production.

Evaluation and Management of Pelvic Inflammatory Disease: The Role of Imaging

Evaluation and Management of Pelvic Inflammatory Disease: The Role of Imaging

Management of pelvic inflammatory disease

Pelvic inflammatory disease (PID) refers to a variety of inflammatory conditions involving the upper genital tract in females. This article aims to increase knowledge of the management of mild to moderate PID by nurse prescribers working in sexual health. An overview of how to identify PID and the types of bacteria that can cause it is provided. The article provides an understanding of the process required to make a diagnosis of PID, and highlights other conditions that may cause similar symptoms. The pharmacological options in treating non-complex mild to moderate presentations of PID are covered.

2012 European guideline for the management of pelvic inflammatory disease

This guideline was produced by the European region of the International Union against sexually transmitted infections (IUSTI) and refers to ascending infections in the female genital tract unrelated to delivery and surgery and does not include actinomyces-related infection.

Pelvic Inflammatory Disease

1. Maria Trent, MD, MPH* 1. *Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD. * CDC: : Centers for Disease Control and Prevention CPP: : chronic pelvic pain CT: : computed tomography IM: : intramuscular IUD: : intrauterine device IV: : intravenous KOH: : potassium hydroxide NAAT: : nucleic acid amplification testing PEACH: : Pelvic Inflammatory Evaluation and Clinical Health PID: : pelvic inflammatory disease STI: : sexually transmitted infection 1. The U. S. Centers for Disease Control and Prevention (CDC) provides evidence-based, expert-driven guidelines for effective management of pelvic inflammatory disease (PID); however, clinician adherence to the guidelines has been problematic. 2. PID practice guideline adherence is an international problem, as evidenced by a 2012 audit in the United Kingdom demonstrating that 55.5% of patients with PID did not receive care according to the British Association of Sexual Health and HIV treatment recommendations. Clinician behavior can be enhanced with the use of institutionally driven protocols, especially those that include onsite dispensing of a full course of medications. 3. Women seeking infertility services who report a history of unexplained and untreated abdominal pain are significantly more likely to have tubal infertility than women without such history; therefore caution should be used in dismissing mild symptoms (mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia) among sexually active patients who may be at risk for PID. After completing this article, readers should be able to: 1. Describe the epidemiology and pathogenesis of pelvic inflammatory disease (PID). 2. Recognize the clinical features of PID. 3. Develop a management strategy for adolescent patients who have PID. 4. Carefully weigh the options for the disposition of patients who have PID. Justine is a 17-year-old girl who presents for evaluation of lower abdominal pain that has been increasing over the past few days. Earlier today she was eating and drinking, but has developed some nausea in the past couple of hours without vomiting. She has had soft, regular bowel movements that are free of blood and mucus. She denies dysuria, but has had some light vaginal discharge that started about 1 week ago. Justine continues to …

P27 An audit on the management of pelvic inflammatory disease (PID)

BackgroundThe 2005 (revised in 2011) UK national guidelines on the management of PID state two auditable outcomes: (1) Proportion of women receiving treatment with a recommended regimen—target 95%. (2) Proportion of named male contacts screened for infection and/or treated—target 0.4 (large urban centres) or 0.6 (other centres) per index case. The guidelines also recommend patients with moderate or severe PID are reviewed after 72 h and all patients are reviewed after 2–4 weeks.AimsTo audit the management, follow-up and partner notification (PN) of PID in our clinic.MethodsRetrospective notes review of PID cases presenting between December 2009 and July 2011. Data were collected on drug treatment, follow-up and PN. Cases with a sexually transmitted infection (STI) were compared to cases with no STI identified.ResultsOf 130 PID cases identified, 58 had an STI diagnosed of whom seven hadNeisseria gonorrhoeae(GC) and 57 hadChlamydia trachomatis(CT). Six cases had both GC and CT. One patient had no documentation of drugs prescribed and one received only Doxycycline (see abstract P27 table 1).Abstract P27 Table 1Management of patients diagnosed with PIDSTI identified (n=58)No STI identified (n=72)Partner notification (PN) Partner notified21 (36.2%)19 (26.4%) Partner notified and treated20 (34.5%)5 (6.9%) PN recommended6 (10.3%)0 No documentation of PN31 (53.5%)53 (73.6%)Treatment prescribed Doxycycline and metronidazole46 (79.3%)59 (81.9%) Macrolide and metronidazole6 (10.4%)7 (9.7%) Ofloxacin and metronidazole (GC cover)5 (8.6%)5 (7.0%) Cephalosporin prescribed (GC cover)40 (69.0%)44 (61.1%)Follow-up Follow-up advised in 3 days00 Follow-up advised in 2–4 weeks47 (81%)69 (95.8%) Follow-up attended47 (81%)29 (40.3%)ConclusionBASHH guidelines recommend GC cover for all PID cases but the proportion receiving this was 72.9%. All cases diagnosed with GC received GC cover. PN rates did not reach national recommendations and this may be related to diagnostic uncertainty especially when no STI is apparent. PN was better in cases with a STI where health advisers were involved than in cases without an STI, seen by doctors. No patients were advised to return for follow-up within 3 days but the majority returned within 2–4 weeks. Those with an STI diagnosed were significantly more likely to attend follow-up p&lt;0.0001.