Pelvic inflammatory disease is an important risk factor for infertility, ectopic pregnancy and chronic pelvic pain. Although the Centers for Disease Control and Prevention published treatment guidelines for pelvic inflammatory disease in 2002, the effectiveness of treatment has been affected by the emergence of quinolone-resistant Neisseria gonorrhoeae. The prevalence of quinolone-resistant Neisseria gonorrhoeae is highly variable with time and place. In Hong Kong, quinolone-resistant Neisseria gonorrhoeae is over 90%, thus ceftriaxone, doxycycline and metronidazole should be the treatment of choice. For patients sensitive to cephalosporins, azithromycin and metronidazole can be considered as alternative treatments.
WestromL.Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries.Am J Obstet Gynecol1980; 138(7 Pt 2): 880–92.
3.
HillisS.D., OwensL.M., MarchbanksP.A., AmsterdamL.F., Mac KenzieW.R.Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease.Am J Obstet Gynecol1997; 176(1 Pt 1): 103–7.
RossJ.D.Pelvic inflammatory disease: how should it be managed?Curr Opin Infect Dis2003; 16(1): 37–41.
8.
CrombleholmeW.R., SchachterJ., Ohm-SmithM., LuftJ., WhiddenR., SweetR.L.Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin.Am J Med1989; 87(5A): 142S–147S.
9.
ThadepalliH., MathaiD., ScottiR., BansalM.B., SavageE.Ciprofloxacin monotherapy for acute pelvic infections: a comparison with clindamycin plus gentamicin.Obstet Gynecol1991; 78(4): 696–702.
10.
SweetR.L.Anaerobic infections of the female genital tract.Am J Obstet Gynecol1975; 122(7): 891–901.
11.
BieluchV.M., TallyF.P.Pathophysiology of abscess formation.Clin Obstet Gynaecol1983; 10(1): 93–103.
12.
TangO.S.The microbial etiology of acute pelvic inflammatory disease in Queen Mary Hospital.HK Pract1996; 18(3): 92–5.
13.
HaggertyC.L., HillierS.L., BassD.C., NessR.B.Bacterial vaginosis and anaerobic bacteria are associated with endometritis.Clin Infect Dis2004; 39(7): 990–5.
14.
SainiS., GuptaN., Aparna, BatraG., AoraD.R.Role of anaerobes in acute pelvic inflammatory disease.Indian J Med Microbiol2003; 21(3): 189–92.
15.
WalkerC.K., WorkowskiK.A., WashingtonA.E., SoperD., SweetR.L.Anaerobes in pelvic inflammatory disease: implications for the Centers for Disease Control and Prevention's guidelines for treatment of sexually transmitted diseases.Clin Infect Dis1999; 28 Suppl 1: S29–36.
16.
HaggertyC.L., NessR.B., AmorteguiA., HendrixS.L., HillierS.L., HolleyR.L.Endometritis does not predict reproductive morbidity after pelvic inflammatory disease.Am J Obstet Gynecol2003; 188(1): 141–8.
17.
NessR.B., SoperD.E., HolleyR.L., PeipertJ., RandallH., SweetR.L.Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial.Am J Obstet Gynecol2002; 186(5): 929–37.
18.
Centers for Disease Control and Prevention.Areas around the world with increased QRNG prevalence. [Online]. 2004 Apr 26 [cited 2005 Mar 8];[1 screen]. Available from: http://www.cdc.gov/std/gisp/IncreasedPrevAreas.htm
19.
KamK.M., LaiC.F., EgglestoneS., ChanC.B.Patterns of antibiotic susceptibility of gonococci isolated in Hong Kong, 1987–1990.Sex Transm Dis1992; 19(5): 284–7.
20.
KamK.M., LoK.K., HoN.K., CheungM.M.Rapid decline in penicillinase-producing Neisseria gonorrhoeae in Hong Kong associated with emerging 4-fluoroquinolone resistance.Genitourin Med1995; 71(3): 141–4.
21.
KamK.M., KamS.S., CheungD.T., TungV.W., AuW.F., CheungM.M.Molecular characterization of quinolone-resistant Neisseria gonorrhoeae in Hong Kong.Antimicrob Agents Chemother2003; 47(1): 436–9.
22.
LingJ.M., LamA.W., ChanE.W., ChengA.F.What have we learnt from community-acquired infections in Hong Kong?J Antimicrob Chemother2003; 51(4): 895–904.
23.
Centers for Disease Control and Prevention (C.D.C.)Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men–United States, 2003, and revised recommendations for gonorrhea treatment, 2004.MMWR Morb Mortal Wkly Rep2004; 53(16): 335–8.
24.
Antimicrobial resistance in gonococci, WHO Western Pacific Region, 1996.The WHO Western Pacific Region Gonococcal Antimicrobial Surveillance Programme.Commun Dis Intell1997; 21(23): 349–53.
25.
ShigemuraK., OkadaH., ShirakawaT., TanakaK., ArakawaS., KinoshitaS.Susceptibilities of Neisseria gonorrhoeae to fluoroquinolones and other antimicrobial agents in Hyogo and Osaka, Japan.Sex Transm Infect2004; 80(2): 105–7.
26.
KamK.M., WongP.W., CheungM.M., HoN.K., LoK.K.Quinolone-resistant Neisseria gonorrhoeae in Hong Kong.Sex Transm Dis1996; 23(2): 103–8.
27.
HandsfieldH.H., DaluZ.A., MartinD.H., DouglasJ.M.Jr, McCartyJ.M., SchlossbergD.Multicenter trial of single-dose azithromycin vs. ceftriaxone in the treatment of uncomplicated gonorrhea. Azithromycin Gonorrhea Study Group.Sex Transm Dis1994; 21(2): 107–11.
28.
MartinD.H., MroczkowskiT.F., DaluZ.A., McCartyJ., JonesR.B., HopkinsS.J.A controlled trial of a single dose of azithromycin for the treatment of chlamydial urethritis and cervicitis. The Azithromycin for Chlamydial Infections Study Group.N Engl J Med1992; 327(13): 921–5.
29.
ThorpeE.M.Jr, StammW.E., HookE.W.3rd, GallS.A., JonesR.B., HenryK.Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises.Genitourin Med1996; 72(2): 93–7.
MalhotraM., SharmaJ.B., BatraS., AroraR., SharmaS.Ciprofloxacin-tinidazole combination, fluconazoleazithromicin-secnidazole-kit and doxycycline-metronidazole combination therapy in syndromic management of pelvic inflammatory disease: a prospective randomized controlled trial.Indian J Med Sci2003; 57(12): 549–55.
33.
BevanC.D., RidgwayG.L., RothermelC.D.Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease.J Int Med Res2003; 31(1): 45–54.
34.
GordonE.M., BlumerJ.L.Rationale for single and high dose treatment regimens with azithromycin.Pediatr Infect Dis J2004; 23(2 Suppl): S102–7.
