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Guidelines
Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID)

Definition

PID is an infection of the female upper genital tract involving any combination of the endometrium, fallopian tubes, pelvic peritoneum and contiguous structures

Refer to The Canadian Guidelines on Sexually Transmitted Infections for further guidance on screening, testing, and management

Common Organisms

  • PID is a polymicrobial infection with multiple microbial etiologies
  • N. gonorrhoeae and C. trachomatis commonly involved, anaerobic organisms

Management

  • Early diagnosis and treatment are crucial to the maintenance of fertility
  • Antibiotic therapy can be administered orally or parenterally, in inpatient or outpatient settings
  • Individuals treated as outpatients need careful follow-up and should be re-evaluated 2 to 3 days after therapy is initiated
  • If no clinical improvement has occurred, hospital admission for parenteral therapy, observation and consideration for laparoscopy is required
  • Surgical emergencies such as appendicitis cannot be excluded
  •  Pregnancy
  • Inadequate clinical response to oral antimicrobial therapy
  • Patient unable to follow or tolerate an outpatient oral regimen
  • Severe illness, nausea and vomiting, or high fever
  • Tubo-ovarian abscess

Consider hospitalization for observed oral or parenteral therapy in the following cases:

  • HIV infection
  • Youth/adolescents (particularly if compliance is an issue)
  • Goals of treatment are to control the acute infection and to prevent long-term sequelae such as infertility, ectopic pregnancy and chronic pelvic pain
  • Treatment regimens should provide empiric broad-spectrum coverage of likely etiologic pathogens and take into account the polymicrobial nature of PID
  • Treatment regimens should provide coverage for N. gonorrhoeae, C. trachomatis, Gram-negative facultative bacteria and streptococci
  • Anaerobic coverage should be considered