Service de Chirurgie Gynécologique et Médecine de la Reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France.
Antenne de Conseil en Infectiologie Départementale, 80 avenue Georges Pompidou, 24000 Périgueux, France.
J Gynecol Obstet Hum Reprod. 2020 May;49(5):101714. doi: 10.1016/j.jogoh.2020.101714. Epub 2020 Feb 20.
Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1 g, once, IM or IV, doxycycline 100 mg ×2/day, and metronidazole 500 mg ×2/day PO for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1-2 g/day until clinical improvement, doxycycline 100 mg ×2/day, IV or PO, and metronidazole 500 mg ×3/day, IV or PO for 14 days (grade B). Drainage of TOA is indicated if the pelvic fluid collection measures more than 3 cm (grade B). Follow-up is required in women with sexually transmitted infections (STIs) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3-6 months after PID (grade C), before the insertion of an intrauterine device (grade B), and before elective termination of pregnancy or hysterosalpingography. When specific bacteria are identified, antibiotics targeted at them are preferable to systematic antibiotic prophylaxis.
当自发性盆腔疼痛伴有诱导性附件或子宫疼痛时,应怀疑盆腔炎性疾病(PID)(B 级)。为排除输卵管卵巢脓肿(TOA),需行盆腔超声检查(C 级)。微生物学诊断需要对宫颈和 TOA 进行采样,进行分子和细菌学分析(B 级)。对于单纯性 PID,一线治疗方案为头孢曲松 1 g,单次肌内或静脉注射,多西环素 100 mg×2/天,甲硝唑 500 mg×2/天口服,疗程 10 天(A级)。对于复杂性 PID,一线治疗方案为静脉注射头孢曲松 1-2 g/天,直至临床改善,多西环素 100 mg×2/天,静脉或口服,甲硝唑 500 mg×3/天,静脉或口服,疗程 14 天(B 级)。如果盆腔积液量超过 3 cm,则需要引流 TOA(B 级)。对于性传播感染(STI)患者,需要进行随访(C 级)。建议使用避孕套(B 级)。PID 后 3-6 个月,在放置宫内节育器(B 级)之前,以及选择性终止妊娠或子宫输卵管造影术之前,建议进行阴道微生物诊断采样(C 级)。如果确定了特定的细菌,则应使用针对这些细菌的抗生素,而不是进行系统性抗生素预防。