In well-appearing patients, an alternate therapy includes levofloxacin (500 mg orally daily for 14 days), but these patients require close follow-up to determine if symptoms are improving, as well as a test of cure at the conclusion of therapy.

Inpatient treatment regimens closely follow outpatient recommendations. The CDC recommends one of these two regimens:

• Cefoxitin (2 g IV every 6 hours) or cefotetan (2 g IV every 12 hours) plus doxycycline (100 mg IV or p.o. every 12 hours).
• Clindamycin (900 mg IV every 8 hours) plus gentamicin loading dose (2 mg/kg) followed by a maintenance dose (1.5 mg/kg every 8 hours). Either regimen results in a clinical cure in more than 90% of cases.¹⁸

Many patients initially admitted for parenteral therapy can be transitioned to oral therapy to complete the course; this transition typically occurs 24 hours after sustained clinical improvement.¹⁵

the cdc recommends that health care providers maintain a low threshold for diagnosis and empiric treatment of presumed PID.

Complications

Even with prompt diagnosis and appropriate treatment of PID, complications are frequent, resulting from the scarring and adhesion formation that develop while the infected organs heal.

Immediate complications include tubo-ovarian abscess and Fitz-Hugh-Curtis syndrome, while the longterm complications include chronic pelvic pain, infertility, and ectopic pregnancy.

Tubo-ovarian abscess (TOA) is one of the most immediate and life-threatening complications of PID. Up to one-third of patients may experience this complication, which occurs when purulent material gains access to the ovary via the fallopian tube.

TOA is a polymicrobial infection that leads to worsening abdominal pain with unilateral adnexal tenderness and fever. Patients with TOA should be hospitalized until they begin to improve, as abscess rupture is a surgical emergency and can rapidly lead to sepsis, shock, and death.

Fitz-Hugh-Curtis syndrome refers to a perihepatitis resulting from peritoneal dissemination of PID. Inflammation and swelling of the liver capsule lead to pleuritic right upper quadrant pain.

Fitz-Hugh-Curtis syndrome affects up to a quarter of women diagnosed with PID, and in chronic cases, the formation of adhesions can lead to persistent pain.²⁰

Chronic pelvic pain, defined as infraumbilical pain of at least 6 months’ duration that is severe enough to cause functional disability, is one of the causes of long-term morbidity following a case of PID.

Chronic pelvic pain occurs in up to one-third of women who are diagnosed with PID, and there is currently no cure. Recurrent episodes of PID are the strongest predictor in the development of chronic pelvic pain.²¹