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[Pelvic Inflammatory Diseases: Updated Guidelines for Clinical Practice - Short version].

  • Brun, J-L1
  • Castan, B2
  • de Barbeyrac, B3
  • Cazanave, C3
  • Charvériat, A4
  • Faure, K5
  • Mignot, S4
  • Verdon, R6
  • Fritel, X4
  • Graesslin, O7
  • 1 Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France. Electronic address: [email protected] , (France)
  • 2 Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 27, avenue Impératrice-Eugénie, 20303 Ajaccio, France. , (France)
  • 3 Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France. , (France)
  • 4 Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. , (France)
  • 5 Service des maladies infectieuses, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France. , (France)
  • 6 Service de maladies infectieuses et tropicales, CHRU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France. , (France)
  • 7 Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, 45, rue Cognacq-Jay, 51092 Reims, France. , (France)
Published Article
Gynecologie, obstetrique, fertilite & senologie
Publication Date
May 01, 2019
DOI: 10.1016/j.gofs.2019.03.012
PMID: 30880245


To provide up-to-date guidelines on management of pelvic inflammatory disease (PID). An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines. PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100mg×2/d, and metronidazole 500mg×2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2g/d until clinical improvement, doxycycline 100mg×2/d, IV or PO, and metronidazole 500mg×3/d, IV or PO for 14days (grade B). Drainage of TOA is indicated if the collection measures more than 3cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions. Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota. Copyright © 2019 CNGOF, SPILF. Published by Elsevier Masson SAS.. All rights reserved.

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