Pelvic Inflammatory Disease Treatment

Risk Factors

Risk factors for severe or recurrent PID include:

• Multiple sexual partners or a new sexual partner
• History of previous PID or sexually transmitted infections
• Young age (under 25 years)
• Intrauterine device insertion in the preceding 3 weeks
• Previous gynaecological procedures
• Immunosuppression

Who Is at Risk?

Sexually active women under 25 years of age are at highest risk of PID. Women with a history of previous PID, multiple partners, or those who have recently had an intrauterine device inserted are also at significant risk. Incomplete antibiotic treatment increases the risk of recurrent disease.

Diagnosis

Diagnosis of PID is primarily clinical and includes:

• Pelvic examination with cervical motion tenderness assessment
• High vaginal and endocervical swabs for culture and STI testing
• Blood tests including white cell count, CRP, and ESR
• Pelvic ultrasound to identify tubo-ovarian abscess
• Laparoscopy in cases of diagnostic uncertainty or failure to respond to antibiotics
• Pregnancy test to exclude ectopic pregnancy

Treatment Options

Mild to moderate PID is treated with dual antibiotic therapy as an outpatient. Severe PID with tubo-ovarian abscess or systemic signs requires hospital admission for intravenous antibiotics. If the abscess does not resolve, surgical drainage by laparoscopy or ultrasound-guided aspiration is required. Treatment of sexual partners is essential to prevent reinfection.

Laparoscopic Drainage of Abscess

Laparoscopic drainage for tubo-ovarian abscess complicating severe PID involves:

• General anaesthesia by specialist team
• Small keyhole incisions for laparoscopic access
• Direct visualisation of pelvic organs and the abscess
• Careful aspiration and drainage of the abscess cavity
• Thorough peritoneal washout with warm saline
• Lysis of adhesions to restore pelvic anatomy
• Specimens sent for microbiological culture and sensitivity
• Drain placement if required for ongoing drainage

Laparoscopic drainage provides faster recovery and allows direct assessment of tubal damage compared to open surgery.

After the Surgery

Post-treatment care after severe PID includes:

• Completion of the full prescribed antibiotic course
• Abstinence from sexual intercourse until treatment is fully complete
• Testing and treatment of all recent sexual partners
• Follow-up at 72 hours for inpatient cases to confirm antibiotic response
• Review at 4 weeks to confirm resolution and assess for complications
• Repeat swabs to confirm clearance of the causative organism

Possible Complications of Severe PID

Complications of severe or recurrent PID include:

• Tubo-ovarian abscess requiring drainage or salpingo-oophorectomy
• Fallopian tube scarring causing infertility or ectopic pregnancy risk
• Chronic pelvic pain from adhesion formation
• Hydrosalpinx – fluid-filled blocked fallopian tube
• Perihepatitis (Fitz-Hugh-Curtis syndrome)
• Peritonitis and systemic sepsis in severe untreated cases
• Psychological impact and reduced quality of life