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Pelvic Inflammatory Disease (PID) | Questions & Answers | 2010 Treatment Guidelines

Question 1: If a patient is diagnosed with pelvic inflammatory disease (PID) and has an intrauterine device (IUD), is the recommendation not to remove IUD?

Answer: Correct. PID treatment does not need to be altered by the presence of an IUD.

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Question 2: Would the treatment be the same if a pelvic inflammatory disease (PID) was in a mentally handicapped person [i.e., due to poor genital hygiene and unlikely sexually transmitted disease (STD)]?

Answer: PID is a polymicrobial infection, with organisms that reflect vaginal and rectal flora as well as STDs. Therefore, the standard treatment regimens are appropriate for both sexually associated and nonsexually associated PID. For example, gentamicin/clindamycin is recommended for other pelvic infections, such as post-partum endometritis.

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Question 3: The new 2010 STD Treatment Guidelines recommend treatment of sexual partners of females with pelvic inflammatory disease (PID), irrespective of their chlamydia/gonorrhea culture results. This would lead to large numbers of males being treated with antibiotics. In these cases what organism would I treat them for? Does CDC recommend doxycycline, augmentin, azithromycin, or other treatment? Is there any evidence for this recommendation?

Answer: The 2010 STD Treatment Guidelines (page 67) state that, "male sex partners of women with PID should be examined and treated if they had sexual contact with the patient during the 60 days preceding the patient’s onset of symptoms. If a patient’s last sexual intercourse was >60 days before onset of symptoms or diagnosis, the patient’s most recent sex partner should be treated. Patients should be instructed to abstain from sexual intercourse until therapy is completed and until they and their sex partners no longer have symptoms. Evaluation and treatment are imperative because of the risk for reinfection of the patient and the strong likelihood of urethral gonococcal or chlamydial infection in the sex partner. Male partners of women who have PID caused by C. trachomatis and/or N. gonorrhoeae frequently are asymptomatic. Sex partners should be treated empirically with regimens effective against both of these infections, regardless of the etiology of PID or pathogens isolated from the infected woman." See the treatment recommendations for chlamydia and gonorrhea in the 2010 STD Treatment Guidelines. The Guidelines also recommend (page 67) that, "even in clinical settings in which only women are treated, arrangements should be made to provide care or appropriate referral for male sex partners of women who have PID. Expedited partner treatment and enhanced patient referral are alternative approaches to treating male partners of women who have chlamydia or gonococcal infections.”

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