Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Pelvic inflammatory disease - Management
Basis for recommendation

Choice of contraception

  • These recommendations are based on the UK Medical Eligibility Criteria (UKMEC) for contraceptive use [FFPRHC, 2006] and a guideline from the Faculty of Sexual and Reproductive Healthcare [FSRH, 2007].

Intrauterine device (IUD)

  • A review of the World Health Organization's experience of pelvic inflammatory disease (PID) associated with IUD use from around the world included 12 randomized studies and one non-randomized study, and found that [FSRH, 2007]:
    • Amongst 22,908 IUD insertions and during 51,399 woman-years of follow up, the overall rate of PID was 1.6 cases per 1000 years of use.
    • The risk of PID was six-fold higher during the 20 days after IUD insertion than during later times.

Testing for bacterial vaginosis

  • CKS recommends taking a high vaginal swab to look for other vaginal infections such as bacterial vaginosis.

Recommendation on antibiotic prophylaxis

  • The recommendation to test for sexually transmitted infections (STIs), or prescribe prophylactic antibiotics if testing for STIs is not possible or has not been completed, before IUD insertion is based on expert opinion in guidelines from the National Institute for Health and Clinical Excellence [NICE, 2005] and the Faculty of Sexual and Reproductive Healthcare [FSRH, 2007] as the risk of PID following insertion of an IUD where infection is present is unknown.
    • Both guidelines recommend testing for STIs and prescribing prophylactic antibiotics if testing for STIs is not possible or has not been completed before an IUD is inserted in women at increased risk of STIs. Woman who have a history of PID are at increased risk of STIs.
  • However, there is good evidence from a Cochrane systematic review that the use of doxycycline or azithromycin orally before IUD confers little benefit even in populations with a high prevalence of STIs.

Sterilization

  • These recommendations are based on the UKMEC for contraceptive use [FFPRHC, 2006].

Protection against STIs

  • Evidence supports the use of male or female condoms to reduce the risk of several sexually transmitted infections (STIs). For more information see the section on Barrier methods in preventing STIs in the CKS topic on Contraception. However, even with consistent and correct use, infections may still (rarely) be transmitted [FFPRHC, 2007a].

© NHS Institute for Innovation and Improvement