Chlamydia infection

Even though this has been covered elsewhere on the site and in more detail, it is important that we have a fresh review here. This is because Chlamydia is the commonest sexually transmitted bacterial infection. It is also an infection that many young people carry without being aware. It is without symptoms in up to 70% of those affected. It is estimated that roughly 10% of young women under 25 years of age are actively infected with Chlamydia at any one time. If the infection is confirmed and other types of infections ruled out, Chlamydia is treated using:

v Azithromycin 1 gram orally as a single dose or;

v Doxycycline 100 mg twice daily orally for 7 days or

v Ofloxacin 400 mg orally once daily for 7 days or;

v Erythromycin 500 mg twice daily orally for 14 days.

Ofloxacin and Erythromycin are only used if, for whatever reason, the other two cannot be used. Doxycycline is not used in pregnancy.

PID in pregnancy

It is extremely rare for a woman to develop pelvic inflammatory disease during pregnancy. In theory, a pre-existing pelvic infection can flare up. If there is strong suspicion of PID in pregnancy, a combination of antibiotics that are safe to use at this time could be given. One of those combinations recommended is Azithromycin as a single dose plus a 14 day course of Cefotaxime and Metronidazole. Doxycycline is not used in pregnancy.

PID in the presence of an intrauterine contraceptive device (coil)

Contrary to the myth, the intrauterine contraceptive device does not cause or increase the risk of pelvic infection. Multiple sexual partners is the main risk factor.

Normally the device will be left in place while the woman is on antibiotics. If there is no clinical improvement after three days into the course, the device can be removed. However, there is a theoretical risk of pregnancy as the prevention of implantation effect of the device will be lost. If fertilization of the egg had already taken place, the woman could end up pregnant. This needs to be borne in mind.

Treating sexual contacts

It is important that current and recent sexual contacts are traced, informed, offered tests and treated. This is particularly important where Chlamydia has been identified as the causative organism. Chlamydia can remain relatively silent even in men. Gonorrhoea is almost always symptomatic in men. Where facilities allow, this exercise ought to be organised via the genitor-urinary medicine (GUM) clinic. If the bacteria causing the pelvic infection is confirmed to be not of the sexually transmitted variety, tracing and treating of sexual contacts is unnecessary.

After PID: Future contraception.

A woman treated for PID can use a contraceptive of her choice. If she is likely to continue having multiple sexual partners in the future and prefers the intrauterine contraceptive device, then a Levonorgestrel releasing device (Mirena) should be offered. This is because it is known to offer some protection against pelvic infection. However, it is important to make clear that the protection is by no means total and the mainstay of avoiding repeat infection is to avoid unprotected sex especially with multiple partners. Protection should be in the form of barrier methods (condoms).

Possible complications resulting from PID

Any woman treated for pelvic infection needs to be given adequate information to understand the importance of taking measures to minimise risk of recurrence. Recurrence is particularly bad news because it significantly increases the risk of all the potential long-term complications of PID mentioned below:

v Sub-fertility or infertility: Even a single episode of PID, especially if treated late, can result in fallopian tubal damage and subsequent inability to conceive. Rates of infertility among women who have one episode of pelvic infection range from 12 to 50%

v Ectopic pregnancy: this is six times more likely in women who have had an episode of PID compared to those who have never had. The risk increases with the number of episodes.

v Chronic pelvic pain: Around one in five women who have had a single episode of pelvic infection will suffer from a long term problem of pelvic pain. This may also include pain during intercourse.

Last update: March 10, 2011