Follow-up
Clinical symptoms should improve within 3 days of commencing antibiotics. Outpatients should be advised to return for further evaluation if this is not the case. Imaging studies, hospitalization for intravenous therapy, or surgical intervention may be indicated.
A routine assessment 2-4 weeks after treatment is recommended to assess the clinical response, adherence to antibiotics, that the individual abstained from sexual contact, and her partners received treatment. It is also an opportunity to check understanding of PID and its sequelae. For those with positive microbiological tests at baseline, repeat testing after 2-4 weeks may be appropriate, particularly in those with persisting symptoms, where poor adherence to antibiotics or partner notification is suspected, or where first-line antibiotic treatment was not used.Box 43.1 Health promotion messages for patients
• An explanation of what treatment is being given and its possible adverse effects.
• Following treatment, fertility is usually maintained but there remains a risk of future infertility, chronic pelvic pain, or ectopic pregnancy.
• Clinically more severe disease is associated with a greater risk of sequelae.
• Repeat episodes of PID are associated with an exponential increase in the risk of infertility.
• The earlier treatment is given, the lower the risk of future fertility problems.
• Future use of barrier contraception will significantly reduce the risk of PID.
• The need to screen her sexual contacts for infection to prevent her becoming reinfected.
Source data from Ross J, McCarthy G. UK National Guidelines for the Management of Pelvic Inflammatory Disease 2011. London, United Kingdom: British Association for Sexual Health & HIV; 2011. (http://www.bashh.org/documents/3572.pdf). (Accessed 8 March 2016).