Ah-Kit X, Hoarau L, Graesslin O, Brun J-L
Pôle d'obstétrique - reproduction - gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
Gynecol Obstet Fertil Senol. 2019 May;47(5):458-464. doi: 10.1016/j.gofs.2019.03.009. Epub 2019 Mar 13.
To determine the procedures for follow-up and counselling of patients after pelvic inflammatory disease (PID).
A search in the Cochrane database, PubMed, and Google was performed using keywords related to follow-up and PID to identify reports published between 1990 and 2018. All studies published in French and English relevant to the areas of focus were included. A level of evidence (LE) based on the quality of the data available was applied for each area of focus and used for the guidelines.
The rate of recurrent PID is 15 to 21%. They are related to a recurrent sexually transmitted infection (STI) in 20 to 34% of cases. Recurrence PID increase the risk of infertility and chronic pelvic pain (LE2). Follow-up is recommended after PID (grade C). The rate of patients lost to follow-up is around 40%. Follow-up is improved by personalized text message reminders (grade B). Vaginal sampling for detection of N. gonorrhoeae, C. trachomatis, (and M. genitalium) by nucleic acid amplification techniques is recommended 3 to 6 months after treatment of PID associated with STI to rule out possible reinfections (grade C). The use of condoms after PID associated with STI is recommended to reduce the risk of recurrences (grade C). The systematic use of contraceptive pills after PID is not recommended to prevent subsequent infertility and chronic pelvic pain. Vaginal sampling for microbiological diagnosis is recommended before the insertion of an intrauterine device (grade B). The risk of ectopic pregnancy is high in these women and must be kept in mind.
Patient counselling and microbiological testing after PID decrease the risk of STI and thus the recurrence of PID.
确定盆腔炎（PID）患者的随访及咨询程序。
使用与随访和PID相关的关键词在Cochrane数据库、PubMed及谷歌上进行检索，以识别1990年至2018年发表的报告。纳入所有与重点领域相关的法语和英语发表的研究。根据可用数据质量为每个重点领域应用证据水平（LE）并用于制定指南。
PID复发率为15%至21%。其中20%至34%的病例与复发性性传播感染（STI）有关。PID复发会增加不孕和慢性盆腔疼痛的风险（证据水平2）。建议在PID后进行随访（C级）。失访患者比例约为40%。个性化短信提醒可改善随访情况（B级）。对于与STI相关的PID，建议在治疗后3至6个月通过核酸扩增技术进行阴道采样检测淋病奈瑟菌、沙眼衣原体（及生殖支原体），以排除可能的再感染（C级）。建议在与STI相关的PID后使用避孕套以降低复发风险（C级）。不建议在PID后常规使用避孕药丸来预防后续的不孕和慢性盆腔疼痛风险。建议在宫内节育器插入前进行阴道微生物学诊断采样（B级）。这些女性异位妊娠风险较高，必须予以关注。
PID后的患者咨询和微生物检测可降低STI风险，从而降低PID复发风险。
