The following criteria enhance specificity and support the diagnosis5:
- oral temperature > 101°F (> 38.3°C),
- abnormal cervical mucopurulent discharge or cervical friability,
- presence of “abundant numbers of white blood cells on saline microscopy of vaginal fluid,”
- elevated erythrocyte sedimentation rate (reference range, 0–20 mm/hr),
- elevated C-reactive protein (reference range, 0.08-3.1 mg/L), and
- laboratory documentation of cervical infection with N gonorrhoeae or C trachomatis.
The CDC also suggests that the most specific criteria for PID include5
- endometrial biopsy consistent with endometritis,
- imaging (transvaginal ultrasound or magnetic resonance imaging) demonstrating fluid-filled tubes, or
- laparoscopic findings consistent with PID.
Treatment of PID includes IV antibiotics
Due to the polymicrobial nature of PID, antibiotics should cover not only gonorrhea and chlamydia but also anaerobic pathogens. CDC guidelines recommend the following treatment5,6:
- intravenous (IV) cefotetan (2 g bid) plus doxycycline (100 mg PO or IV bid),
- IV cefoxitin (2 g qid) plus doxycycline (100 mg PO or IV bid), or
- IV clindamycin (900 mg tid) plus IV or intramuscular (IM) gentamicin loading dose (2 mg/kg) followed by a maintenance dose (1.5 mg/kg tid).
In mild-to-moderate PID cases deemed appropriate for outpatient therapy, the following regimens have been shown to have similar outcomes to IV therapy5,6:
- IM ceftriaxone (250 mg, single dose) plus PO doxycycline (100 mg bid) for 14 days with/without PO metronidazole (500 mg bid) for 14 days,
- IM cefoxitin (2 g, single dose) and PO probenecid (1 g, single dose) plus PO doxycycline (100 mg bid) for 14 days with/without PO metronidazole (500 mg bid) for 14 days, or
- other parenteral third-generation cephalosporin plus PO doxycycline (100 mg bid) for 14 days with/without PO metronidazole (500 mg bid) for 14 days.
Management in older women may be more intensive
Due to the increased risk of malignancy in postmenopausal women with TOA, surgical intervention may be needed.3,4
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