Special considerations
Tubo-ovarian abscess
Tubo-ovarian abscess is a serious and potentially life-t hreatening complication of PID (Figure 43.7). Patients are more likely to be systemically unwell, and have higher levels of pelvic pain.
The palpation of an adnexal mass, or lack of response to therapy, should prompt imaging studies. Tubo-ovarian abscess is an indication for hospital admission for parenteral antimicrobial therapy, with appropriate anaerobic cover, and to monitor for signs of rupture or sepsis. Conservative management may be effective with studies showing resolution in 70-84% of women, particularly those with smaller abscesses (60 days ago) in the CDC 2015 guidelines (2). The European and United Kingdom guidelines both recommend tracing contacts within a 6-month period, although recognize this time period is not evidence based (40, 59). Recent partners should receive empirical treatment for chlamydia regardless of symptoms or laboratory results in either individual (59). If adequate screening for gonorrhoea is not available, then empirical treatment for this infection should also be given (40).To minimize disease transmission, women should be instructed to abstain from sexual intercourse until therapy is completed, symptoms have resolved, and sex partners have been adequately treated. Rest should be advised for those with severe disease, and appropriate analgesia must be provided. Diagnosis and treatment of PID offers an opportunity to provide health promotion information including clear written material (Box 43.1).
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