Active Ingredients: Azithromycin
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The requirement that all three minimum criteria be present before the initiation of empiric treatment could result in insufficient sensitivity for the diagnosis of PID.
After deciding whether to initiate empiric treatment, clinicians should also consider the risk profile for STDs.
More elaborate diagnostic evaluation frequently is needed because incorrect diagnosis and management of PID might cause unnecessary morbidity. For example, the presence of signs of lower-genital—tract inflammation predominance of leukocytes in vaginal secretions, cervical exudates, or cervical friability, in addition to one of the three minimum criteria, increases the specificity of the diagnosis.
Most women with PID have either mucopurulent cervical discharge or evidence of WBCs on a microscopic evaluation of a saline preparation of vaginal fluid i.
If the cervical discharge appears normal and no WBCs are observed on the wet prep of vaginal fluid, the diagnosis of PID is unlikely, and alternative causes of pain should be considered.
A wet prep of vaginal fluid also can detect the presence of concomitant infections e.
The most specific criteria for diagnosing PID include: endometrial biopsy with histopathologic evidence of endometritis; transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic infection e.
A diagnostic evaluation that includes some of these more extensive procedures might be warranted in some cases.
Endometrial biopsy is warranted in women undergoing laparoscopy who do not have visual evidence of salpingitis, because endometritis is the only sign of PID for some women.
Treatment PID treatment regimens must provide empiric, broad spectrum coverage of likely pathogens.
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