Pediatric emergency medicine trisk 2139 2139
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of oral antibiotics because of either poor compliance or vomiting and for those
whose illnesses have not responded to prior oral antibiotics.
Patients diagnosed with PID should receive follow-up care within 3 days of an
ED visit. The average duration of symptoms among women with gonococcal
salpingitis treated with oral antibiotics is 3 to 4 days; the corresponding interval
for nongonococcal salpingitis is 4 to 6 days. A poor response to therapy should
alert the physician to the possibilities of inadequate compliance, abscess
formation, or an alternative diagnosis.
Follow-up for all patients should include reexamination at the end of antibiotic
therapy to check for residual pelvic tenderness and adnexal masses. All patients
with gonococcal and chlamydial infections should be counseled about the HIV
infection and offered serologic screening for both syphilis and HIV infection.
The importance of identifying and treating sexual partners of women with PID
cannot be overemphasized. About 25% of such men have asymptomatic urethritis
and are unlikely to seek treatment on their own. If these men are not treated, they
become part of the reservoir of undetected carriers of STIs. The success of
various patient referral strategies conducted by public healthcare personnel to
achieve treatment of partners ranges from 29% to 59%. The success rate of
patient-initiated partner treatment is unknown in the adolescent population,
although several small studies in adult women suggest this strategy may reduce
the rate of reinfection. The legal and policy landscape around expedited partner
therapy is complicated and constantly changing; the CDC maintains an up-to-date
website in order to assist clinicians who wish to provide this treatment to patients
( ). In addition, the CDC offers a free
mobile app available for download entitled “the STD Tx Guidelines” for a quick
up-to-date reference guide on the identification and treatment of sexually
transmitted infections. All sexual partners in contact with a patient with PID (or
any STI) within the prior 2 months should be treated.
