[Question #1111] Broad-spectrum antibiotics for PID

51 months ago

Dear Drs,


Hi, thank you for receiving my question. I appreciate for your precious time.

I read on the CDC that all regimens used to treat PID should also be effective against N. gonorrhoeae and Chlamydia because negative endocervical screening for these organisms does not rule out upper-reproductive infection.

I’m confused. Does this mean that broad-spectrum antibiotics, which cover N. gonorrhoeae and Chlamydia, should be used even if results of some PCR (Polymerase Chain Reaction) tests are all negative? Or is this an option of treating person?

 

Why broad-spectrum antibiotics should be used instead of using specific antibiotics for positive PCR results (or using metronidazole only if there is no positive PCR results), monitoring the patient’s condition over time, and add or change antibiotics later?

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago
I see that you remain concerned about PID therapy.  The fact is that in most people with PID, clinicians are treating a syndrome at a time when they do not have test results to guide therapy and therefore broad spectrum coverage in recommended to begin with.  Once test results are available, they may not represent infection present at all sites (for instance there may be different bacteria at the uterine cervix than in the uterus) and furthermore, careful studies done years ago show that in many patients with PID multiple potential pathogenic bacteria may be present simultaneously.  It is for this reason that the CDC and most experts suggest the combined treatment recommended. EWH
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51 months ago

Doctor, I want to cry. I can’t tell where I live, but I live in a country where no official PID treatment information is available for the public. There is no official or unofficial (NGOs) websites for informing people about STDs and PID. I’m amazed how much information is available for the European people and people of the U.S.

I read and read all over again what you wrote for me, and try to keep them in my mind one sentence by one sentence, because it’s really precious information for me. I really need information.. I already read information on the CDC and other English websites, but there were some questions I couldn’t solve by myself.. Please, understand that I’m not posting questions just because of my anxiety. I just desperately need reliable information.. I have more questions and they are mostly related with PID (not just treatment one), however, I will follow the rules and will not ask any question which is repetitive. I really thank you for your help. Your clear and detailed answer is really helping me a lot.

 

Thank you for your answers again, and my questions are..

- If I’m understanding what you told me right, does doxycycline always have to be included in the treatment regimen for 14 days because clinicians begin to treat a syndrome when test results are not available, and even after negative results, the negative results don’t rule out possibility of upper-reproductive infection by Chlamydia or N. gonorrohoeae?

- Is the recommended inpatient treatment by the CDC for just acute PID? I would like to know whether the recommended inpatient treatment have to be changed (ex: type of antibiotics, doses, or treatment period) when treating for several years of untreated PID, or severely ill patients.

- Is Metronidazole effective against Chlamydia or N. gonorrhoeae?

- If patients have upper-reproductive infection by STDs and treated with Metronidazole only, can Metronidazole relieve symptoms and/or cure PID?

- Can patients be cured for PID with Metronidazole only, when there are no positive results?

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

- If I’m understanding what you told me right, does doxycycline always have to be included in the treatment regimen for 14 days because clinicians begin to treat a syndrome when test results are not available, and even after negative results, the negative results don’t rule out possibility of upper-reproductive infection by Chlamydia or N. gonorrohoeae?

Doxycycline is recommended but for some patients, for a variety of reasons medicines other than doxycycline may be substituted.  These medications might include fluoroquinolone antibiotics like levofloxacin or azithromycin. 


- Is the recommended inpatient treatment by the CDC for just acute PID? I would like to know whether the recommended inpatient treatment have to be changed (ex: type of antibiotics, doses, or treatment period) when treating for several years of untreated PID, or severely ill patients.

In some nations chronic PID can be caused by infections other than STIs.  For instance, tuberculosis can cause non-STI PID.  Further there are many other illnesses which can mimic STI PID.  Determining what is happening is best carried out by a doctor who can see such patients repeatedly.   Non-STI PID would require other treatment, depending on the cause.


- Is Metronidazole effective against Chlamydia or N. gonorrhoeae?

No, metronidazole is NOT active against chlamydia or gonorrhea but it is very active against anaerobic bacteria which may cause PID.


- If patients have upper-reproductive infection by STDs and treated with Metronidazole only, can Metronidazole relieve symptoms and/or cure PID?

Yes.


- Can patients be cured for PID with Metronidazole only, when there are no positive results?

Yes


I hope this further information is helpful. It sounds to me as though you would benefit from being seen by a gynecologist.  If you have chronic PID, that is best managed through the care of a health care provider who can address your specific problems and see you repeatedly over time.  EWH


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51 months ago

Thank you for your answers. I’ve been diagnosed as PID before, and went to a hospital for treatment. I appreciate for sharing your knowledge.

I’m sorry but I’m not still clear about some questions I asked..

Regarding #2.. I understand that non-STI PID would require other treatment, but what about several years of untreated severe PID which is caused by anaerobes or STDs from vagina? Can the recommended regimen by the CDC also be applied for the severe one, or it has to be changed its length or add more antibiotics?

Regarding #4 & #5.. I’m sorry but I don’t understand why answers to question #4 & #5 are all yes. As you told me, metronidazole is not active against chlamydia or gonorrhea, but active against for anaerobic bacteria..

Regarding #4…

How can using metronidazole only relieve symptoms and cure PID when patients have upper-reproductive infection caused by STDs such as chlamydia or gonorrhea?

Did you mean that using metronidazole only can relieve symptoms even if patients are suffering from PID caused by chlamydia or some other STDs? Can using Metronidazole only cure PID caused by Chlamydia or other STDs?

Regarding #5…

I don’t understand.. Even if there are no positive results, according to what you told me before and what was written on the CDC, “negative endocervical screening for organisms doesn’t rule out upper-reproductive-tract infection caused by chlamydia or gonorrhea (CDC).” Doesn’t this mean that there could be infection caused by Chlamydia or gonorrhea even if negative results are present? How can using metronidazole only cure PID in a case it is caused by Chlamydia but no positive results present?

 

Also, I have questions regarding your answers to my the other post.

I think my questions were not written clearly.. What I wanted to ask were..

- Do people who stop taking therapy before completing 14 days of recommended course have more possibility of a recurrence of PID than who complete 14 days?

- I don’t know it’s a myth or truth. I heard people who had PID before can have a recurrence of PID just because of too much stress, even if they don’t have any sexual activity. Is this true?

 

1) Can you rule out possibility of someone having PID based on results of blood tests, such as ESR, CRP, and CA 125 when all results are within a normal range?

Do they always rise without exception when someone has PID?

2) Can someone have PID (chronic one or untreated one for several years) or infection in her body even if her results of blood tests are all within normal range?

I know this is my third question. I apologize for asking strange questions. Thank you so much for your time and help. I hope you have a great day.. J

Edward W. Hook M.D.
Edward W. Hook M.D.
51 months ago

Final responses to this thread:

Regarding #2.. The recommended CDC regimen would be the way to go and effective for most patients irrespective of the severity of infection.  After that care must be individualized by the treating physician based on clinical and laboratory response.

Regarding #4  thus is a repetitive question.  metronidazole alone would not be expected to cure PID, either when caused by gonorrhea, chlamydia or other bacteria.

.Regarding #5…Doesn’t this mean that there could be infection caused by Chlamydia or gonorrhea even if negative results are present? How can using metronidazole only cure PID in a case it is caused by Chlamydia but no positive results present?  See above, I would not treat PID with metronidazole alone.

1) Can you rule out possibility of someone having PID based on results of blood tests, such as ESR, CRP, and CA 125 when all results are within a normal range?

Do they always rise without exception when someone has PID?

NO, blood tests may support the diagnosis of PID but the DO NOT make the diagnosis. the blood tests you list may be normal or abnormal in persons with PID. 

2) Can someone have PID (chronic one or untreated one for several years) or infection in her body even if her results of blood tests are all within normal range?

Another repetitive question. See response above. 


I sense your frustration although I know little about your situation.  I doubt that you are going to get answers which you find satisfying from me or any other on-line source.  Rather, if you have a chronic problem which you believe is PID, my advice would be to find a physician who will and can work with you to address your problems to fix those things that can be fixed and clarify those which cannot. 

this will end this thread and it will be closed later today.  I wish you well.  EWH


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