Updated French guidelines for diagnosis and management of pelvic inflammatory disease.

BACKGROUND: Pelvic inflammatory disease (PID) is commonly encountered in clinical practice. OBJECTIVES: To provide up-to-date guidelines on management of PID. SEARCH STRATEGY: An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in May 2015. SELECTION CRITERIA: All identified reports relevant to the areas of focus were included. DATA COLLECTION AND ANALYSIS: A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines. MAIN RESULTS: PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade C). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (grade B). Microbiological diagnosis requires vaginal and endocervical sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ofloxacin and metronidazole for 14days (grade B). Treatment of tubo-ovarian abscess is based on drainage if the collection measures more than 3cm (grade B), with combined ceftriaxone, metronidazole, and doxycycline for 14-21days. CONCLUSIONS: Current management of PID requires easily reproducible investigations and treatment, and thus can be applied worldwide.

Pelvic inflammatory disease in women with endometriosis is more severe than in those without.

AIMS: To determine the incidence and severity of acute pelvic inflammatory disease (PID) or tubo-ovarian abscess (TOA) in hospitalised women with and without a history of endometriosis. METHODS: Retrospective analysis of hospital records retrieved for all women hospitalised with PID or TOA between January 2008 and December 2011 in a tertiary referral centre. Women were compared with regard to a history of endometriosis for demographic, clinical and fertility data. RESULTS: 26 (15%) of the 174 women hospitalised due to PID or TOA were excluded because of age older than 45 years, leaving 148 for analysis. The mean age was 35.7 ± 9.3 years and mean duration of hospitalisation was 5.9 ± 3.7 days. The women were divided into two groups: Group 1 with endometriosis (n = 21) and Group 2 without endometriosis (n = 127). Women in Group 1 as compared with Group 2 were significantly more likely to have undergone a fertility procedure prior to being admitted to the hospital with PID (9/27 (45%) vs 22/121 (17%), P < 0.001); particularly in vitro fertilisation (IVF) (7/ 27 (33%) vs 12/121 (9%), P < 0.006); Women in Group 1 more frequently experienced a severe and complicated course involving longer duration of hospitalisation (8.8 ± 4.7 vs 4.4 ± 2.3 days, P < 0.0001) and antibiotic treatment failure (10/27 (48%) vs 8/121 (6%), P < 0.0001). CONCLUSIONS: Pelvic inflammatory disease in women with endometriosis is more severe and refractory to antibiotic treatment, often requiring surgical intervention. It is likely that endometriosis is a risk factor for the development of severe PID, particularly after IVF treatment.

Estimation of the rate of pelvic inflammatory disease diagnoses: trends in England, 2000-2008.

BACKGROUND: Pelvic inflammatory disease (PID) is difficult to define and diagnose; therefore, a standardized methodology for identifying and monitoring PID diagnoses is required. We estimated the rate of PID in general practice in England, and investigated variations by definition of PID, time, age, and geographical area. METHODS: We analyzed the United Kingdom General Practice Research Database between 2000 and 2008. Definitions of "definite," "probable," and "possible" PID among female patients (aged 16 to 44 years) were determined according to medical codes that denoted diagnoses or symptoms indicative of PID. Diagnoses rates were calculated per 100,000 person-years (py). Trends were assessed using Poisson regression. RESULTS: The rate of clinical PID diagnoses was 281/100,000 py (95% confidence interval [95% CI]: 277-286) for definite cases; 326/100,000 py (95% CI: 321-331) for definite and probable cases; and 1117/100,000 py (95% CI: 1107-1126) for definite, probable, and possible cases. During 2000 to 2008, the rate of definite/probable PID decreased by 10.4% per year (95% CI: 9.7-11.1; P<0.001). Rates declined in all areas and among all age groups with greatest decline in women aged 16 to 19 years. Meanwhile, the rate of possible PID increased. CONCLUSIONS: The definition of PID used has a major effect on the rate and trends over time. There was heterogeneity in rates of definite/probable PID by age and region, but homogeneity with regard to a trend of declining rates. Ongoing monitoring of PID diagnoses, with standard case definitions, will contribute to the evaluation of chlamydia screening in England.

Concerns regarding the Centers for Disease Control's published guidelines for pelvic inflammatory disease.

The International-Infectious Disease Society for Obstetrics and Gynecology-USA (I-IDSOG-USA) has concerns about the most recently published Centers for Disease Control and Prevention (CDC) guidelines for pelvic inflammatory disease (PID). I-IDSOG-USA advocates the following changes when the guidelines are revised. We recommend the use of the term "upper genital tract infection" (UGTI), followed by the designation of the etiologic agent, instead of the currently employed term, "pelvic inflammatory disease," or PID. In diagnoses, there should be greater emphasis on signs and symptoms related to subclinical or occult UGTI. Therapeutic recommendation for the treatment of UGTI should be documented for various stages of this diverse disease entity. There should be greater emphasis on hospitalization for infected nulligravida teenagers. This permits monitoring of antibiotic treatment and provides a site for medical educational efforts to teach this medically underserved segment of our society how to protect their future fertility, their health, and their lives.

[Role of the immune parameter neopterin in adnexitis]. / Bedeutung des Immunparameters Neopterin bei der Adnexitis.

Neopterin is a sensitive marker of macrophage activity, and elevated urine excretion has been observed in viral and bacterial infections. Including 48 patients, we investigated whether neopterin could be a valid parameter for classification of PID. Urinary Neopterin was determined pretherapeutically and throughout the follow-up by means of high pressure liquid chromatography. In about one third of the patients elevated levels of neopterin were observed and these were characterized by higher PID-scores, accelerated erythrocyte sedimentation rate and higher levels of C-reactive protein. The results indicate that in patients with PID macrophages are regularly activated. Neopterin may give additional information for classification of PID although because of lack of sensitivity and specificity it may not be helpful for differential diagnosis or follow-up of these patients.

Conceptos, diagnósticos y tratamiento del plastrón anexial y absceso tubo-ovárico no roto / Concepts, diagnosis and treatment of the anexial mass and non broken tubal-ovaric abscess

La precisión y la diferenciación de los grados, fases o estadíos de la enfermedad pélvica inflamatoria darán las pautas para el manejo y tratamiento sucesivos, siendo la clasificación de Gainesville muy útil (1). El presente trabajo identifica una entidad, el "Plastrón anexial" cuyo manejo no requiere de cirugía y contribuye a perfeccionar la clasificación antes descrita, separándola del absceso tubo-ovárico que sí requiere de drenaje quirúrgico. Las pautas para la identificación del "Plastrón Anexial", permiten desde el inicio tomar una decisión definitiva en cuanto a la conducta a seguir

Conservative approach to the management of pelvic inflammatory disease.

Clinical criteria and treatment protocols are outlined for 663 cases of mild, moderate and severe pelvic inflammatory disease (PID). Data on 176 patients requiring admission to hospital and who were treated conservatively with antibiotics are analysed. Criteria for operative intervention are outlined; only 1 patient required surgical intervention. The study suggests that, provided strict criteria are adhered to, conservative management of PID is both safe and effective and offers outlying hospitals and rural practitioners a plan of management that can be safely followed before resorting to referral to major centres.

Pelvic inflammatory disease in Zimbabwe. Guidelines for diagnosis and treatment.

PIP: Pelvic inflammatory disease (PID) from the perspective of African practitioners is reviewed: diagnosis, staging and treatment. PID is the most common disorder treated in the gynecological department, and is a major public health problem because of the large number of patients, prolonged hospital stays, high mortality rate, and serious late sequelae of chronic pain, infertility and ectopic pregnancy. Diagnosis is difficult without confirmation by laparoscopy. PID is probable in complaints of acute abdominal pain, arising just after menses, with cervical excitation tenderness upon vaginal examination. The most reliable laboratory finding is accelerated sedimentation rate. State I is acute PID without peritoneal irritation; Stage II involves peritonitis and bilateral lower quadrant rebound tenderness; State III is a mass or abscess; Stage IV is rupture of the tubo-ovarian abscess. Culdocentesis producing gross pus suggests polymicrobial infection. The goals of treatment are to cure the patient and reach all of her partners, and to prevent late sequelae. Stage I patients can be treated with oral antibiotics as outpatients. Stage II can be effectively treated with penicillin and chloramphenicol in 80% in Zimbabwe. Stage III can sometimes be treated with antibiotics, but usually requires early surgery, by colpotomy if possible. Aggressive use of 3 antibiotics e.g., penicillin, clindamycin and gentamicin, will cover enteric organisms. Stage IV is life-threatening, with a mortality rate of 30-50% from septic shock. Total abdominal hysterectomy and bilateral adnexectomy are advised. A table depicting management of PID is included.^ieng

The value of laparoscopy in the diagnosis of acute pelvic inflammatory disease.

A total of 40 patients with acute pelvic inflammatory disease (acute PID) were examined over a period of 7 months to determine the diagnostic value of laparoscopic examination in these cases. The most important findings were: the clinical diagnosis of acute PID was confirmed by laparoscopy in 55% of patients; laparoscopy was especially of value in differentiating potentially lethal conditions such as ectopic pregnancy and acute appendicitis from acute PID in 15% of patients; laparoscopically obtained microbiological specimens provide a more accurate means of determining the microbiological aetiology of acute PID than vaginally obtained specimens.