Pelvic inflammatory and Trichomoniasis treatment and antibiotics

Pelvic inflammatory disease   

Management

Pelvic inflammatory disease (PID) is usually caused by a STI, particularly in women aged under 25 years, women who have had recent change of sexual partner or women with a previous history of gonorrhoea or chlamydia. Diagnosis of PID is clinical, taking into account the history, clinical findings and results of tests. However, STI tests will often be negative and a low threshold for treatment is appropriate. Treatment should cover infection with gonorrhoea, chlamydia and anaerobes.
Women with severe pelvic inflammatory disease and women who are pregnant require referral for specialist assessment. Hospital admission may be required for IV antibiotics.  

Common pathogens

Chlamydia trachomatis, Neisseria gonorrhoeae and others  
Antibiotic treatment for Pelvic inflammatory disease  

First choice Ceftriaxone 

Adult: 500 mg IM, stat (make up with 2 mL of 1% lignocaine or according to data sheet)
AND
Doxycycline
Adult: 100 mg, twice daily, for 14 days
AND
Metronidazole
Adult: 400 mg, twice daily, for 14 days (metronidazole may be discontinued if not tolerated)  

Alternatives

Ceftriaxone 

500 mg IM, stat + azithromycin 1 g on day one and day eight is an alternative if compliance is likely to be poor. Ornidazole may be considered as an alternative, if metronidazole is not tolerated.  

Trichomoniasis   

Management

Advise avoidance of unprotected sexual intercourse for seven days after treatment has been initiated, and for at least seven days after any sexual contacts have been treated, to avoid re-infection.
Due to low sensitivity, culture of urethral swabs is rarely positive in males, even if infection is present, therefore empirical treatment of male sexual contacts is recommended without testing, along with a STI check.
A test of cure is not usually required unless there is a risk of re-exposure.  

Common pathogens

Trichomonas vaginalis  
Antibiotic treatment for Trichomoniasis  

First choice Metronidazole

Adult: 2 g, stat
Can be used in women who are pregnant or breast feeding, but advise to avoid breastfeeding for 12–24 hours after dose  

Alternatives

For those intolerant of the stat dose, use metronidazole 400 mg, twice daily, for seven days
Ornidazole 1.5 g, stat or 500 mg, twice daily, for five days may be used instead of metronidazole, but is not recommended in women who are pregnant as no study data is available

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