Pelvic Inflammatory Disease: Review of Treatment Options

Decisions regarding appropriate antibiotic therapy for treatment of pelvic inflammatory disease (PID) are complicated by an incomplete understanding of the syndrome. Further, the lack of data on laparoscopic diagnosis and cure of PID severely limits our ability to interpret data on therapy outcome. Validation studies of the treatment regimens recommended by the Centers for Disease Control in the 1985 treatment guidelines for sexually transmitted diseases (STDs) suggest that both the cefoxitin/doxycycline and clindamycin/aminoglycoside combination regimens result in consistently high rates of clinical evidence of cure. The 1989 STD treatment guidelines were based on these studies and on available data regarding newer treatment regimens. Empiric, broad-spectrum therapy remains the treatment of choice. The two regimens recommended for inpatient therapy in 1989 are similar to those recommended in 1985. The recommendation for management of ambulatory patients has been substantially changed, however, because of increasing resistance of Neisseria gonorrhoeae to penicillin. Pelvic inflammatory disease (PID) is an oftenserious consequence of gonococcal and chlamydial infection. An estimated 1 million women in the United States are treated each year for this condition, and at least one-fourth of these women will suffer one or more serious sequelae, including infertility, ectopic pregnancy, and major abdominal/pelvic surgery. It has been estimated that the cost of these sequelae will be $3.5 billion per year [1] by 1990. Since the early 1970s, the Centers for Disease Control (CDC) has recommended therapeutic regimens for PID as part of the treatment guidelines for sexually transmitted diseases (STDs). In this report we will review the current understanding of PID as a clinical syndrome, the 1985 CDC recommendations and their rationale, and the advances that have been made in the understanding of the diagnosis and treatment of PID since 1985. We will also make further recommendations for PID treatment regimens.