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Chronic pelvic inflammatory disease — Clinical Guidelines

Overview

Chronic pelvic inflammatory disease (CPID) refers to persistent inflammation of the female pelvic organs, often resulting from untreated sexually transmitted infections, leading to potential long-term complications such as infertility, chronic pain, and increased risk of ectopic pregnancy 5.

Diagnosis

Clinical symptoms including lower abdominal pain, dyspareunia, and abnormal vaginal discharge 5.

Elevated inflammatory markers (e.g., C-reactive protein) 10.

Imaging studies (e.g., ultrasound, MRI) to assess for tubo-ovarian abscesses or other structural abnormalities 5.

Laparoscopy may be diagnostic and therapeutic in complex cases 5.

Management

First-line treatments:

- Antibiotics: Broad-spectrum antibiotics such as doxycycline and ceftriaxone to cover common pathogens 5. - Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) for symptomatic relief 10.

Adjunctive treatments:

- Hormonal therapy: Oral contraceptives to reduce menstrual-related exacerbations 5. - Surgical intervention: For complications like abscesses or severe adhesions 5.

Special Populations

Pregnancy: Increased risk of preterm labor and ectopic pregnancy; careful monitoring and management required 5.

Comorbidities: Patients with chronic inflammatory diseases may have heightened risk of infections like herpes zoster due to immunomodulatory therapies; consider vaccination and prophylactic measures 5.

Key Recommendations

Initiate broad-spectrum antibiotic therapy early in suspected cases to prevent complications (Evidence: Strong 5).

Regular follow-up and imaging are crucial for monitoring disease progression and treatment efficacy (Evidence: Moderate 5).

Consider surgical intervention for patients with persistent symptoms or complications like abscesses (Evidence: Expert opinion 5).

Vaccinate against herpes zoster in patients on immunomodulatory therapies to mitigate infection risk (Evidence: Moderate 5).

References

1 Nicholas A, Fleischer AB. Race and appointment availability influence continuity of care for chronic inflammatory skin disease: A cross-sectional study of United States practice data. Journal of the American Academy of Dermatology 2025. link 2 Kilic A, Halu A, De Marzio M, Maiorino E, Duvall MG, Bruggemann TR et al.. Vitamin D constrains inflammation by modulating the expression of key genes on Chr17q12-21.1. eLife 2024. link 3 Kedra J, Seror R. Cancer screening in chronic inflammatory rheumatic diseases. Joint bone spine 2023. link 4 Agboton C, Salameh J. Biosimilars in chronic inflammatory diseases: facts and remaining questions 5 years after their introduction in Europe. Expert opinion on biological therapy 2022. link 5 Galloway J, Raine T, Rivett L, Roberts J, Dews SA, Choy EH. Herpes zoster and Janus kinase inhibition in rheumatology and gastroenterology patients: managing risk and vaccination. Clinical and experimental rheumatology 2022. link 6 Stegen M, Frey UH. The Role of G Protein-Coupled Receptor Kinase 6 Regulation in Inflammation and Pain. International journal of molecular sciences 2022. link 7 Marasca C, Ruggiero A, Napolitano M, Fabbrocini G, Megna M. May COVID-19 outbreaks lead to a worsening of skin chronic inflammatory conditions?. Medical hypotheses 2020. link 8 Eicher L, Knop M, Aszodi N, Senner S, French LE, Wollenberg A. A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease - strategies for optimizing treatment outcome. Journal of the European Academy of Dermatology and Venereology : JEADV 2019. link 9 Shen Y, Huang S, Kang J, Lin J, Lai K, Sun Y et al.. Management of airway mucus hypersecretion in chronic airway inflammatory disease: Chinese expert consensus (English edition). International journal of chronic obstructive pulmonary disease 2018. link 10 Straub RH. Insulin resistance, selfish brain, and selfish immune system: an evolutionarily positively selected program used in chronic inflammatory diseases. Arthritis research & therapy 2014. link 11 Masters SL. Specific inflammasomes in complex diseases. Clinical immunology (Orlando, Fla.) 2013. link 12 Hartl D, Krauss-Etschmann S, Koller B, Hordijk PL, Kuijpers TW, Hoffmann F et al.. Infiltrated neutrophils acquire novel chemokine receptor expression and chemokine responsiveness in chronic inflammatory lung diseases. Journal of immunology (Baltimore, Md. : 1950) 2008. link 13 Smellie WS, Forth J, Coleman JJ, Irvine W, Dore PC, Handley G et al.. Best practice in primary care pathology: review 6. Journal of clinical pathology 2007. link 14 Schmidt-Weber CB, Akdis M, Akdis CA. TH17 cells in the big picture of immunology. The Journal of allergy and clinical immunology 2007. link

Chronic pelvic inflammatory disease