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Pelvic inflammatory disease - Management
Basis for recommendation
These recommendations are based on expert advice in guidelines from the Royal College of Obstetricians and Gynaecologists, the British Association for Sexual Health and HIV [BASHH, 2005a], and the European guideline for the management of pelvic inflammatory disease [Ross et al, 2008].
Complications of pelvic inflammatory disease (PID)
- Tubal infertility:
- There is evidence from prospective cohort studies that the risk of infertility is related to the number of episodes of pelvic inflammatory disease (PID) and their severity: 0.6% of women had tubal-factor infertility after an episode of mild PID, and 21.4% of women had tubal-factor infertility after an episode of severe PID.
- The risk of ectopic pregnancy is increased ten-fold after one episode of PID [Oakeshott, 2003].
- Estimates vary but chronic pelvic or abdominal pain (lasting for more than 6 months) develops in 18% of women who have had PID [Drife and Magowan, 2004]. There is evidence from a large randomized trial of 831 women who have had an episode of mild-to-moderate PID that chronic pelvic pain may be present in 34% of women at a mean follow up of 35 months [Ness et al, 2002].
- About a third of women have repeated infections [Drife and Magowan, 2004].
Discontinuation of metronidazole if it is not tolerated
- Although anaerobes may have a role in the pathogenesis of PID, they are probably of more importance in women who have severe PID. Expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009], the British Association for Sexual Health and HIV [BASHH, 2005a], and the European guideline for the management of pelvic inflammatory disease [Ross et al, 2008], based on studies which have not included metronidazole but have had good outcomes, is that if the PID is not severe and metronidazole is not tolerated then it may be stopped.
Referral for contact tracing and screening
- These recommendations are based on expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009] and the British Association for Sexual Health and HIV [BASHH, 2005a].
Avoiding unprotected sexual intercourse
- These recommendations are based on expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009] and the British Association for Sexual Health and HIV [BASHH, 2005a].
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