Management of PID: pain relief, prompt antibiotics and partner notification
Pelvic inflammatory disease (PID), an infection of the genital tract, is treated with pain relief, prompt antibiotics and, when a sexually transmitted infection (STI) is suspected or found, partner notification.
Remember
Treat suspected PID promptly with pain relief and broad-spectrum antibiotics (drugs active against many types of bacteria), without waiting for swab results. Notify and test recent sexual partners when an STI is suspected or found, and offer them testing even when the woman's cervical STI tests (tests of the cervix, the neck of the womb) are negative.
Pelvic inflammatory disease is an infection that spreads upwards from the vagina and cervix (the neck of the womb) into the uterus, fallopian tubes and ovaries. It is polymicrobial, meaning that several kinds of bacteria are usually involved at once, and it is often caused by sexually transmitted infections such as chlamydia and gonorrhoea.
Treatment rests on three things: analgesia (pain relief), antibiotics to treat the infection, and contact tracing (finding and testing recent sexual partners), which applies when an STI is suspected or found. Antibiotics treat the cause but do not work instantly, so the pain needs treating in its own right. Everyday painkillers such as paracetamol or ibuprofen can help.
The antibiotics should be broad-spectrum, chosen to cover gonorrhoea, chlamydia and the normal vaginal bacteria, including anaerobes (bacteria that live without oxygen). They are started promptly and empirically, which means before test results are back, because swab results can take days and a negative swab does not rule PID out. Untreated infection can scar the fallopian tubes, leading to infertility, ectopic pregnancy (a pregnancy growing outside the womb) and chronic pelvic pain.
The woman is also tested for STIs. Partner care matters because partners who are not treated can pass the infection back and reinfect the patient. Recent sexual partners should be offered STI testing and appropriate treatment, even when her cervical STI tests are negative.
Most women are treated as outpatients, because mild to moderate PID does not need admission to hospital. Admission is reserved for situations such as severe symptoms, pregnancy or an inability to tolerate oral treatment. Surgery is reserved for complications such as an abscess (a pocket of pus) that does not settle with antibiotics. Steroids are not part of the standard plan, since the treatment is antibiotics.
Key facts
- Three parts of care
- pain relief, antibiotics and contact tracing when an STI is suspected or found.
- Antibiotic cover
- gonorrhoea, chlamydia and the normal vaginal bacteria, including anaerobes.
- Timing
- start antibiotics when PID is suspected, because a negative swab does not rule PID out.
- Painkillers
- paracetamol or ibuprofen can ease the pain while the antibiotics work.
- Setting
- mild to moderate PID does not need hospital admission.
- Review
- women should seek urgent advice if they do not feel better after 3 days of antibiotics.
Exam traps
- Steroids are not a treatment for PID: it is an infection, so despite 'inflammatory' in its name, steroids would not clear the bacteria.
- Waiting for swab results before starting antibiotics delays treatment, because results can take days and a negative swab does not rule PID out.
- Advising sexual partners to seek testing only if they develop symptoms is not enough, because most people with chlamydia, a common cause of PID, have no symptoms, and an untreated partner can pass the infection back.
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