Microbiology
Infections
Question 50 of 77
A 23 year old woman presents to ED complaining of fever and pelvic pain for the last 24 hours. She reports that she has been experiencing a burning sensation while passing urine and an abnormal offensive-smelling discharge for the past week. On examination she has suprapubic tenderness and cervical excitation. Which of the following antibiotics would be most appropriate to start in this patient:
Answer:
The patient most likely has pelvic inflammatory disease most commonly caused by Chlamydia trachomatis or Neisseria gonorrhoeae. Treatment should not wait for laboratory confirmation. First line treatment is with doxycycline + metronidazole + single-dose of i/m ceftriaxone or ofloxacin + metronidazole (suggested duration of treatment 14 days).Pelvic Inflammatory Disease
Microbiology / Infections
Last Updated: 8th April 2019
Infectious Agents
- Neisseria gonorrhoeae
- Chlamydia trachomatis
- Mixed anaerobic infection
Clinical Disease
- Symptoms
- Fever
- Pelvic or lower abdominal pain
- Deep dyspareunia
- Abnormal vaginal bleeding (intermenstrual or postcoital)
- Abnormal vaginal or cervical discharge
- Right upper quadrant pain due to perihepatitis (Fitz-Hugh-Curtis syndrome)
- Signs
- Lower abdominal or pelvic tenderness
- Adnexal, cervical motion or uterine tenderness
- Abnormal cervical or vaginal discharge
Complications
- Tubal infertility
- Ectopic pregnancy
- Chronic pelvic pain
Diagnosis
- Clinical diagnosis
- Endocervical and high vaginal swabs should be taken for nucleic acid amplification tests (NAATs)
Treatment
- Contact tracing recommended
- First Line: Doxycycline + metronidazole + single-dose of i/m ceftriaxone or ofloxacin + metronidazole
- Suggested duration of treatment 14 days (except i/m ceftriaxone)
- In severely ill patients initial treatment with doxycycline + i/v ceftriaxone + i/v metronidazole, then switch to oral treatment with doxycycline + metronidazole to complete 14 days’ treatment
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
