Pelvic Inflammatory Disease Essays

Pelvic Inflammatory Disease Essays

Module 8: Discussion

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Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration.

History includes:

LMP 2 weeks ago (regular)
Reports oral contraceptive use
Reports pain in lower abdomen with cramping and pain on urination for 3 days
Denies any GI problems, reports regular bowel movements.

Denies vaginal discharge
Ann is married and in a monogamous relationship. Has one child age 2
Reports no use of condoms/sexual intercourse 2-3 times per week
Denies any history of STDs

Physical Exam reveals:

Temp 100. 6, P 80 BP 100/62 Wt. 125 Ht. 5’3’’
HEENT WNL
No CVA tenderness
Pain in lower quadrants with light palpation. Positive inguinal lymphadenopathy
External genitalia without lesions or discharge
Pelvic exam reveals minimal cervical mucopus
Bimanual exam reveals uterine and adnexal tenderness and cervical motion pain Pelvic Inflammatory Disease Essays. Uterus anterior, midline, smooth, not enlarged

  1. Based on the above case the diagnosis is PID,  What is an appropriate CDC-recommended therapeutic regimen for this patient?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.

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    • Module 8Subscribe
    • Steven Bartos posted Mar 10, 2021 7:22 PM
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    • PID, otherwise known as pelvic inflammatory disease, is an infection of the upper reproductive tract, which is likely caused by a sexually transmitted infection, such as Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. Some patients are asymptomatic, while others present with severe abdominal pain where surgery is a necessary intervention Pelvic Inflammatory Disease Essays. Cervical motion tenderness, uterine tenderness, and adnexal tenderness are other confirming signs that diagnosis PID. Regularly screening for PID and diagnosing the disease early on is important, as complications can occur if left untreated, such as tubal infertility, ectopic pregnancy, and chronic pelvic pain (Das et al., 2016).In the case scenario, Ann’s symptoms are not severe yet; therefore, the following regimens are recommended for intramuscular / oral treatment administration on an outpatient basis: Ceftriaxone 250 mg IM in a single dose + Doxycycline 100 mg orally twice a day for 14 days, with or without Metronidazole 500mg orally twice a day for 14 days; or Cefoxitin 2g IM in a single dose and Probenecid, 1 g orally administered concurrently in a single dose + Doxycycline 100mg orally twice a day for 14 days, with or without Metronidazole 500 mg orally twice a day for 14 days; or other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime) + Doxycycline 100 mg orally twice a day for 14 days, with or without Metronidazole 500mg orally twice a day for 14 days (CDC, 2015).ReferencesDas, B.B., Ronda, J., & Trent, M. (2016). Pelvic inflammatory disease: Improving awareness, prevention, and treatment. Infection and Drug Resistance, 9, 191 – 197. https://doi.org/10.2147/IDR.S91260less1 UnreadUnread3 ViewsViews
    • 1 RepliesReplies
    • View profile card for Aina Oluwo
    • Last post March 14 at 10:37 PM by Aina Oluwo
    • CDC. (2015). Pelvic inflammatory disease (PID). U.S. Department of Health and Human Services. https://www.cdc.gov/std/tg2015/pid.htm
    • For a more severe case, or if the patient does not respond to IM / oral therapy should initiate IV therapy, the following parenteral administration regime is recommended: Cefotetan 2 g IV every 12 hours + Doxycycline 100mg orally or IV every 12 hours; Cefoxitin 2 g IV every 6 hours + Doxycycline 100mg orally or IV every 12 hours; Clindamycin 900 mg IV every 8 hours + Gentamicin loading dose IV or IM (2mg/kg), followed by a maintenance dose (1.5 mg/kg) every 8 hours, and single daily dosing (3 – 5 mg/kg) can be substituted; or an alternative regimen of Ampicillin/sulbactam 3 g IV every 6 hours + doxycycline 100mg orally or IV every 12 hours (CDC, 2015).
    •                 According to the CDC, antibiotic treatment should be started once PID is suspected. The CDC recommends hospitalization and likely IV therapy for women who experience the following: when surgery cannot be ruled out; tubo-ovarian abscess; pregnancy; severe illness, nausea and vomiting, or high fever; unable to tolerate or complete oral medications outside the hospital; or no clinical response to oral medications (CDC, 2015) Pelvic Inflammatory Disease Essays.
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    • Sheryl Dixon posted Mar 9, 2021 2:55 AM
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    • Several types of antibiotics can cure  Pelvic Inflammatory Disease( PID). Antibiotic treatment does not, however, reverse any scarring caused by the infection. For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID. Prompt antibiotic treatment can prevent severe damage to the reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes. PID treatment regimens must provide empiric, broad spectrum coverage of likely pathogens. Several parenteral and oral antimicrobial regimens have been effective in achieving clinical and microbiologic cure in randomized clinical trials with short-term follow-upAdditionally, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID. It’s very important to complete the entire course of antibiotics, even if you’re feeling better, to help ensure the infection is properly cleared. In particularly severe cases of PID, you may have to be admitted to hospital to receive antibiotics through a drip in your arm (intravenously) (NHS,2018). CDC.gov. (2015). Pelvic Inflammatory Disease (PID). Retrieved from https://www.cdc.gov/std/tg2015/pid.htmmore1 UnreadUnread2 ViewsViews
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    • View profile card for Caroline Otto
    • Last post March 14 at 2:16 PM by Caroline Otto
    • NHS. (2018). Treatment-Pelvic inflammatory disease, Retrieved from https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/treatment/
    • less1 UnreadUnread4 ViewsViews
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    • View profile card for Eleany Yasein
    • Last post March 14 at 3:08 AM by Eleany Yasein
    • Mayo Clinic. (n.d.). Pelvic inflammatory disease (PID)https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594
    • References
    • The current recommendations by the Centers for Disease Control and Prevention (CDC) include testing the diagnosed woman for HIV, gonorrhea and chlamydia, using the nucleic acid amplification test. The pathogen causing the PID is often unknown therefore, any prescribed treatments need to have a broad spectrum.  There are a variety of current recommended treatments, including various routes including, oral, parental and intramuscular (Centers for Disease, 2015).
    • Module 8Subscribe
    • Hilary Szpara posted Mar 10, 2021 8:10 PM
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    • Pelvic inflammatory disease (PID) is a disease process that includes many different infectious agents, which can damage the endometrium, fallopian tubes, ovaries, and pelvic peritoneum (Curry et al., 2019). Most PID cases are caused by sexually transmitted infections such as chlamydia and gonorrhea, but some cases have been found to be caused by organisms associated with bacterial vaginosis (Curry et al., 2019). A delayed diagnosis of PID can contribute to damage to the reproductive system including infertility, ectopic pregnancy, and chronic pelvic pain (Curry et al., 2019). In the US, approximately 800,000 women are diagnosed with PID every year, but the CDC estimates that closer to one million women actually experience a case of PID every year, this number including missed cases (Das et al., 2016). Because damage that is incurred to the reproductive tract from PID is irreversible, it is important that women are treated quickly with antibiotics. Antibiotic regimens have been found effective in women who have mild to moderate PID (Das et al., 2016). However, there are certain groups of women who may require inpatient treatment, including those who meet any of the following criteria: unable to exclude surgical emergency, pregnancy, tubo-ovarian abscess, failure to respond to oral antibiotics with symptoms not getting better, inability to tolerate outpatient regimen, and those with severe illness such as nausea, vomiting, and/or high fever (Das et al., 2016). After beginning treatment, all patients should be reevaluated by a provider within 72 hours to assess if additional interventions or hospitalization are needed (Das et al., 2016) Pelvic Inflammatory Disease Essays. Based on her symptoms and history, Ann should be started on an outpatient oral antibiotic regimen and reevaluated within 72 hours to determine the need for any further interventions.Das, B. B., Ronda, J., & Trent, M. (2016). Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infection and drug resistance9, 191–197. https://doi.org/10.2147/IDR.S91260Curry, A., Williams, T., Penny, M, L. (2019). Pelvic inflammatory disease: Diagnosis, management, and prevention. American Family Physician, 100(6).less1 UnreadUnread4 ViewsViews
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    • View profile card for Amandeep Kaur
    • Last post March 13 at 11:37 PM by Amandeep Kaur
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    • Amandeep Kaur posted Mar 9, 2021 6:24 PM
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    • The CDC recommends that treatments of pelvic inflammatory disease provide broad spectrum coverage (CDC, 2015). This is to combat the many different pathogens that seem to be involved. These regimens should be able to target N, gonorrhoeae, and C. trachomatis as the screenings for these can be a false negative. The CDC also recommends that the treatment for PID be initiated as soon as the presumptive diagnosis has been made. This to prevent long term sequelae, such as infertility and ectopic pregnancy.  Under certain conditions the individual may need to be hospitalized; pregnancy, tubo-ovarian abscess, severe nausea & vomiting, unable to tolerate outpatient treatment, or no response to oral treatment. Outpatient treatment includes ceftriaxone 250 mg intramuscular and doxycycline 100 mg orally twice a day, for 14 days (AHC MEDIA, 2020). This can be given with or without metronidazole 500 orally twice a day for 14 days. Metronidazole can be added to account for the third-generation cephalosporins.ReferencesAHC MEDIA. (2020). Should Metronidazole Be Added Routinely to Treatment Regimens for PID? Contraceptive Technology Update41(12), 1–2. less1 UnreadUnread2 ViewsViews
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    • View profile card for Joanne Hogan
    • Last post March 13 at 9:59 PM by Joanne Hogan
    • Pelvic inflammatory Disease (PID) – 2015 STD treatment guidelines. (2015, June 4). https://www.cdc.gov/std/tg2015/pid.htm Pelvic Inflammatory Disease Essays.
    • Mod 8 PIDSubscribe
    • Candice Russell posted Mar 8, 2021 4:55 PM
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    • Pelvic Inflammatory Disease (PID) is an infection of female reproductive organs. PID is most often caused by sexually transmitted infections (STI). Women infected with chlamydia and gonorrhea are usually asymptomatic and go undiagnosed, subsequently, the infection is left untreated. Untreated chlamydia and gonorrhea infections are usual causative agents of PID. Prompt treatment of PID is essential to prevent severe, irreversible, damage to the reproductive organs. Delay in treatment can lead to infertility and future ectopic pregnancies, due to damaged fallopian tubes. Treatment with antibiotics can cure PID. Many cases of PID are left untreated because women are asymptomatic, symptoms are mild or nonspecific. The Centers for Disease Control (CDC) states “because of the difficulty of diagnosis and the potential for damage to the reproductive health of women, health-care providers should maintain a low threshold for the diagnosis of PID” (Ness, et al., 2002, as cited by CDC, 2015, para. 4).Presumptive treatment for PID should be initiated in sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain if no cause for illness other than PID can be identified, and if one or more of the following minimum clinical criteria are present on pelvic examination: cervical motion tenderness or uterine tenderness or adnexal tenderness. (CDC, 2015 para. 5)            CDC guidelines recommend treatment regimens “must provide” empiric, broad-spectrum coverage of “likely” pathogens. Treatment regimens used to treat PID should also be effective against N. gonorrhea and C. trachomatis. St Cyr et al. (2020) states “effective treatment can prevent complications and transmission, but N. gonorrhoeae’s ability to acquire antimicrobial resistance influences treatment recommendations and complicates control” (Fleming & Wasserheit, 1999, as cited by St Cyr et al., 2020, p. 1911). Clinical trials were conducted, administration of parenteral and oral antimicrobial regimens was effective “in achieving clinical and microbiologic cure” (CDC, 2015, para. 9). The CDC list several parenteral, oral, and combination intramuscular/oral treatment regimens. Some suggested parenteral (intravenous, IV) medications are cefotetan, doxycycline, and cefoxitin. Oral and combination treatment options are ceftriaxone IM, plus oral doxycycline with or without oral metronidazole or cefoxitin IM and oral probenecid. The CDC, 2015 STD Treatment Guidelines, provide more medication options Pelvic Inflammatory Disease Essays. The need for hospitalization rests upon provider judgment and if certain criteria are met, this also guides treatment options. Criteria set by the CDC for necessary hospitalization:
      • surgical emergencies (e.g., appendicitis) cannot be excluded;
      • tubo-ovarian abscess;
      • pregnancy;
      • severe illness, nausea and vomiting, or high fever;
      • unable to follow or tolerate an outpatient oral regimen; or
      • no clinical response to oral antimicrobial therapy.

      “Women who have had one episode of PID need to prevent STI infection given the relationship between recurrent STIs, such as C. trachomatis and infertility” (Haggerty et al., 2010, as cited by Das et al., 2016, p. 192). Das et al. (2016) state “Prevention of the first episode of PID requires early diagnosis of STIs and therefore improved provider adherence to the United States Preventive Screening Task Force and CDC guidelines” (p. 192). Abstaining from sexual intercourse until completion of treatment, resolution of symptoms, and partner testing minimize disease transmission. Follow-up is extremely important. Centers for Disease Control and Prevention. (2015, June 4). Pelvic Inflammatory Disease (PID) – 2015 STD Treatment Guidelines. Centers for Disease Control and Prevention. https://www.cdc.gov/std/tg2015/pid.htm. St Cyr, S., Barbee, L., Workowski, K. A., Bachmann, L. H., Pham, C., Schlanger, K., Torrone, E., Weinstock, H., Kersh, E. N., & Thorpe, P. (2020). Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Morbidity and mortality weekly report69(50), 1911–1916. https://doi.org/10.15585/mmwr.mm6950a6  less2 UnreadUnread7 Views Views Pelvic Inflammatory Disease Essays

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    • View profile card for Tallona Boddy
    • Last post March 13 at 9:03 PM by Tallona Boddy
    • Das, B. B., Ronda, J., & Trent, M. (2016). Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infection and Drug Resistance, 9, 191-197. http://dx.doi.org.wilkes.idm.oclc.org/10.2147/IDR.S91260
    • Reference:
    • “Treatment should be initiated as soon as the presumptive diagnosis has been made, because prevention of long-term sequelae is dependent on early administration of appropriate antibiotics” (CDC, 2015, para. 7). Patient acceptance, cost and availability should be considered when selecting treatment options. (Smith et al., 2007, as cited by CDC, 2015, para. 7).
    • This patient is sexually active. She reports lower abdominal pain, amongst other symptoms, and meets all three criteria set out by the CDC, cervical motion pain, uterine and adnexal tenderness. Presumptive treatment should be initiated. Furthermore, the pt’s pelvic exam revealed minimal cervical mucopus. The CDC states signs of lower genital tract inflammation, cervical exudate, along with one of the previously mentioned criteria, “increases the specificity of the diagnosis” (CDC, 2015, para. 6).
    • The 2015 STD Treatment Guidelines provided by the CDC states

        ORDER A PLAGIARISM FREE PAPER NOW

    • Pelvic inflammatory diseaseSubscribe
    • Jennifer Bryant posted Mar 9, 2021 1:58 PM
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    • less2 UnreadUnread10 ViewsViews
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    • View profile card for Cassie Fritzinger
    • Last post March 11 at 2:31 PM by Cassie Fritzinger
    • References
    • According to the Centers for Disease Control (CDC), the recommendation of first line treatment for PID is oral antibiotic, doxycycline 100 mg, to be taken twice a day for two weeks (Jennings & Krywko, 2020). In addition, CDC recommends that patients with PID also take one dose of another antibiotic, ceftriaxone 250 mg given intramuscularly (IM) or one dose of cefoxitin 2g, given IM with probenecid that is 1g orally or another parenteral third-generation cephalosporin. If there is a concern for trichomonas or vaginal instrumentation, CDC recommends adding metronidazole (500mg orally twice a day, for 2 weeks) (Jennings & Krywko, 2020). Other parenteral alternative treatments include ampicillin/subactam 3g given intravenously every 6 hours with doxycycline 100mg orally or IV every 12 hours (CDC, 2015). Research show that ceftriaxone has better effect against N. gonorrhoeae. Moreover, cefoxitin has better short-term response when combined with doxycycline than ceftriaxone. Delayed treatment can lead to long-term complications, so early treatment is crucial (CDC, 2015).
    • PID CDC recommended treatmentSubscribe
    • Aina Oluwo posted Mar 10, 2021 9:17 PM
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    • According to Kriesel et al. (2018), Pelvic Inflammatory disease (PID) is a genital tract disorder caused by inflammation of the endometrium, fallopian tubes, ovaries or peritoneum. These inflammation is as a result of infection caused mainly gonorrhea and chlamydia and is common in young sexually active women (Huether et al., 2020).Early treatment is recommended as damage to the reproductive tract can be severe. The 2015 CDC  treatment for PID recommends  outpatient treatment of a single dose 250 mg of intramuscular ceftriaxone  or a third-generation cephalosporin plus oral doxycycline -100 mg twice a day for 14 days with or without oral metronidazole- 500 mg twice a day for 14 days (Petrina et al., 2019).Center for Disease Control and Prevention CDC (2020).Pelvic Inflammatory Disease (PID) –Huether, S., McCance, K., and Brashers, V.  (2020).  UnderstandingKreisel, K., Flagg, E. W., & Torrone, E. (2018). Trends in pelvic inflammatory diseaseand Gynecology, 218(1), 117.e1-117.e10. https://doi.org/10.1016/j.ajog.2017.10.010endometrial isolates recovered from women with clinical pelvic inflammatory disease or65. https://doi.org/10.1016/j.anaerobe.2019.02.005less1 UnreadUnread3 Views Views Pelvic Inflammatory Disease Essays
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    • View profile card for Cassie Fritzinger
    • Last post March 11 at 7:53 AM by Cassie Fritzinger
    • histological endometritis to antimicrobial agents. Anaerobe, 56, 61-
    • Petrina, M., Cosentino, L., Wiesenfeld, H., Darville, T., & Hillier, S. (2019). Susceptibility of
    • emergency department visits, united states, 2006–2013. American Journal of Obstetrics
    •            Pathophysiology (7th ed.).  Elsevier
    • CDC Fact Sheet. (2020, November).  https://www.cdc.gov/std/pid/stdfact-pid.htm
    • References
    • The Center for Disease control (CDC), (2020) indicates there are no tests for PID and recommends a combination of medical history taking, physical assessment and test results aid in diagnosing this disorder. The clinical symptoms associated with PID can be seen to be exhibited by our patient Ann.  Ann presents with fever of 100.6F, pain in lower quadrants with light palpation, cervical mucopus and exams reveals uterine and adnexal tenderness, cervical motion pain and dysuria (CDC, 2020).
    • Module 8 discussionSubscribe
    • Melissa Morgan posted Mar 10, 2021 9:39 PM
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    • Based on Ann’s clinical presentation, it appears she has mild to moderate PID. This disease affects 4% to 12% of young women and is a common cause of morbidity in this age group (Savaris, et al., 2017). PID does not have a specific diagnosis criterion but relies on ruling out other diseases and conditions, and clinical manifestations (Savaris, et al., 2017). Because of this, PID can be difficult to diagnose, and patients can go untreated as a result. Studies have shown that a negative CT or ultrasound does not rule out PID, nor does a negative NAAT laboratory result (Savaris, et al., 2017). CDC recommends board spectrum antibiotics to treat the various pathogens that could potentially be there, which includes parenteral, intramuscular, and oral antimicrobials (Centers for Disease Control and Prevention [CDC], 2015). Since Ann’s PID is not severe, her healthcare provider will likely go with oral and IM antibiotics. However, the CDC has recommended that if a patient’s PID gets worse, or they are not cured, then a course of IV antibiotics will be warranted. “Women who do not respond to IM/oral therapy within 72 hours should be reevaluated to confirm the diagnosis and should be administered intravenous therapy” (CDC, 2015) Pelvic Inflammatory Disease Essays. Drug therapy to treat PID includes ceftriaxone, doxycycline, metronidazole, and cefoxitin, and probenecid (CDC, 2015). Ann is fortunate that her PID has been diagnosed early because untreated PID can cause other conditions/diseases to develop as a consequence of PID. “Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of appropriate antibiotics” (CDC, 2015). Ann should be educated on not engaging in sexual intercourse until her treatment is completed, her symptoms have resolved, and her husband has been tested and treated (CDC, 2015).Jennings, L. K., & Krywko, D. M. (2020). Pelvic Inflammatory Disease. In StatPearls. StatPearls Publishing. Savaris, R. F., Fuhrich, D. G., Duarte, R. V., Franik, S., & Ross, J. (2017). Antibiotic therapy for pelvic inflammatory disease. The Cochrane database of systematic reviews4(4), CD010285. https://doi.org/10.1002/14651858.CD010285.pub2less1 UnreadUnread4 ViewsViews
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    • View profile card for Cassie Fritzinger
    • Last post March 11 at 7:42 AM by Cassie Fritzinger
    • Pelvic inflammatory Disease (PID) – 2015 STD treatment guidelines.  (2015, June 04). Centers for Disease Control and Prevention. Retrieved March 10, 2021, from https://www.cdc.gov/std/tg2015/pid.htm
    • References
    • Dennies JonesSubscribe
    • Dennies Jones posted Mar 9, 2021 3:57 PM
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    •                A 32-year-old patient came in with a complaint of lower abdominal pain, cramping, a slight fever of 100.6 degrees, and dysuria for three days. The patient is married and in a monogamous relationship, reports no use of condoms, and is sexually active 2-3 times a week. Physical exam revealed pain in the lower quadrants with light palpation, positive inguinal lymphadenopathy. The bimanual exam revealed uterine and adnexal tenderness and cervical motion pain. The patient was diagnosed with pelvic inflammatory disease. Park et al. (2017) stated that “pelvic inflammatory disease (PID) is caused by colonization of the endocervix by microorganisms, which then ascend to the endometrium and fallopian tube. Inflammation can be at any point along a continuum that includes endometritis, salpingitis, and peritonitis” (p. 1).  Detailed std facts – pelvic inflammatory disease – CDC fact sheet. (2020, November 19). Retrieved March 07, 2021, from https://www.cdc.gov/std/pid/stdfact-pid-detailed.htmNew Analysis Looks at Pelvic Inflammatory Disease. (2017). Contraceptive Technology Update, 38(4), 1–3.Sung Taek Park, Suk Woo Lee, Min Jeong Kim, Young Mo Kang, Hye Min Moon, Chae Chun Rhim, Park, S. T., Lee, S. W., Kim, M. J., Kang, Y. M., Moon, H. M., & Rhim, C. C. (2017). Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease. BMC Women’s Health, 17, 1–7. https://doi-org.wilkes.idm.oclc.org/10.1186/s12905-016-0356-9less1 UnreadUnread5 ViewsViews
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  • View profile card for Jazmin Jerez-Rivera
  • Last post March 10 at 7:44 PM by Jazmin Jerez-Rivera
  • Reference:
  •           New Analysis Looks at Pelvic Inflammatory Disease (2017) stated that “PID is prevalent and associated with previous STI diagnoses. Therefore, clinicians need to screen the female patients for chlamydia and gonorrhea to reduce the incidence of PID” (p. 2). The recommendation for the patient is to have her husband get tested. According to the Centers for Disease Control and Prevention (CDC), “PID is treated with broad-spectrum antibiotics to cover likely pathogens. Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any scarring that has already been caused by the infection” (2020, para 13). The CDC also explained that Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of appropriate antibiotics. Treatment regimens are based on availability, cost, and patient acceptance. According to the CDC, “when using the parenteral cefotetan or cefoxitin regimens, oral therapy with doxycycline 100 mg twice daily can be used 24–48 hours after clinical improvement to complete the 14 days of therapy.  For the clindamycin/gentamicin regimen, oral therapy with clindamycin (450 mg orally four times daily) or doxycycline (100 mg twice daily) can be used to complete the 14 days of therapy” (2020, para 10).
  • PID the silent sterilizerSubscribe
  • Caroline Otto posted Mar 10, 2021 3:59 PM
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  • Pelvic Inflammatory Disease (PID) causes a substantial health risk to women.Both Neisseria gonorrhoeae and Chlamydia trachomatis may induce changes in the columnar epithelium lining of the upper reproductive tract, causing permanent damage, and the subsequent inflammatory response that occurs causes localized edema and sometimes obstruction or necrosis of the area Pelvic Inflammatory Disease Essays. Acute complications of PID include peritonitis and bacteremia, which can increase the risk for endocarditis, meningitis, and infectious arthritis. The chronic consequences of PID include infertility and tubal obstruction, ectopic pregnancy, and pelvic pain.Abdominal pain in women can have many causes, and all these causes can be ruled out while the patient is being treated for PID.Doxycycline 100mg orally twice a day for seven days is recommended since there’s antibiotic resistance to Azithromycin.I found this rather disheartening, since the Joint Commission and the Center of Medicare Services has placed such rigid guidelines and recommendations on other treatments in our practice, such as Pneumonia, Sepsis, Heart Failure and Myocardial Infarction.This is interesting because it contrasts the different standards of care related to bacterial resistance in different locations all over the world. I understand this because in South America countries Azithromycin can be bought without a prescription, whereas in the US the medication can only be taken with a prescription, so this would provide reasoning to why there is an emerging antimicrobial resistance to Azithromycin.What I find so alarming is that there is no uniformity in the practice of diagnosing and prescribing, however we have so many rigid guidelines for other diseases, which once again uncovers a flaw in our medical system and brings fort an opportunity for change to occur.References: Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology Llata, E., Bernstein, K. T., Kerani, R. P., Pathela, P., Schwebke, J. R., Schumacher, C., Stenger, M., & Weinstock, H. S. (2015). Management of Pelvic Inflammatory Disease in Selected U.S. Sexually Transmitted Disease Clinics: Sexually Transmitted Disease Surveillance Network, January 2010-December 2011. Sexually transmitted diseases42(8), 429–433. https://doi.org/10.1097/OLQ.0000000000000309
  •  St Cyr, S., Barbee, L., Workowski, K. A., Bachmann, L. H., Pham, C., Schlanger, K., Torrone, E., Weinstock, H., Kersh, E. N., & Thorpe, P. (2020). Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR. Morbidity and mortality weekly report69(50), 1911–1916. https://doi.org/10.15585/mmwr.mm6950a6
  • 7th ed. Elsevier Mosby
  • Cueva, F., Caicedo, A., & Hidalgo, P. (2020). A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador Pelvic Inflammatory Disease Essays. Infectious diseases in obstetrics and gynecology2020, 5423080. https://doi.org/10.1155/2020/5423080
  • Presently, it is the antimicrobial resistance of N. gonorrhoeae that is of immediate concern. The WHO maintains a surveillance program through the Gonococcal Antimicrobial Surveillance Program (GASP). In 2016, 17 out of 57 countries reported decreased susceptibility to extended spectrum cephalosporins and 28 out of 57 reported resistance to azithromycin and 56 out of 59 to ciprofloxacin. Its obvious that this shows that N. gonorrhoeae is becoming harder to treat, leaving a limited spectrum of antibiotics available for use, leaving the patient vulnerable.
  • Furthermore, there seems to be no standardized treatment for PID universally as the “European, CDC, and the WHO guidelines recommend different antibiotic regimens in response to their epidemiological data” (Cueva, Caicedo, & Hidalgo, 2020).
  • Various research articles reveal during my reading this week, that although the CDC has recommendations and guidelines to treat suspected PID cases in women, there are women who are not correctly identified and treated. In one study it was revealed that there is little known about how women with PID are diagnosed and treated in the US in sexually transmitted infection clinics, or how closely management guidelines are followed in these settings, including outpatient and emergency department settings (Llata et.al. 2015).
  • I have worked for many years in the Emergency Department. These patients used to be treated with a cocktail. The cocktail included Ceftriaxone 250mg intra-muscular, and Azithromycin 1000mg by mouth, and in some cases the patient was given Flagyl 1000mg by mouth as well, and Diflucan 150mg by mouth. However, the CDC recommendations have changed.
  • Since PID has serious outcomes, and its symptoms may be limited or vague, the Center for Disease Control encourages clinicians to treat all women who have abdominal pain, pelvic tenderness, uterine tenderness and adnexal tenderness, and who are sexually active Pelvic Inflammatory Disease Essays. Furthermore, the CDC does not require any laboratory testing or studies to begin treatment, as the overall thinking is treating the suspected cause benefits the patient even if the patient doesn’t have the disease.
  • According to Huether, McCance, & Brashers, (page 789), the main infectious culprits that cause the majority of Pelvic Inflammatory disease (PID) cases in the United States, are gonorrhea and chlamydia, however recently sexually transmitted infections caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014, and its one of the biggest culprits causing pelvic inflammatory disease, ectopic pregnancies, and infertility, and it has the ability to facilitate the transmission of human immunodeficiency virus (Sancta St Cyr, et. al. 2020) Pelvic Inflammatory Disease Essays.