SOME ADDITIONAL POINTS ABOUT ANTIBIOTIC TREATMENT: Single antibiotics, no matter how powerful, are not appropriate for PID. The use of single cephalosporin antibiotics (a large family of antibiotics whose names often begin with "ceph" or "cef") is a special problem. PID researcher Richard Sweet has shown that these antibiotics will eradicate chlamydia on the cervix, but NOT in the upper genital tract (i.e. the reproductive organs).

PENICILLIN: Penicillin-type antibiotics (penicillin, amoxicillin, ampicillin) are no longer recommended for the treatment of PID. Many bacteria have become resistant to penicillin (including some strains of gonorrhea), and many bacteria are now able to produce enzymes and other substances which make penicillin ineffective. Also, PID usually involves a buildup of large numbers of bacteria, and penicillin works best with small numbers of bacteria. High treatment failure rates have been reported when penicillin has been used to treat PID. These antibiotics are not on the Canadian or the U.S. recommended guidelines.

TETRACYCLINE: This antibiotic is similar to doxycycline (both are part of the same antibiotic family), but doxycycline has a broader range (it kills more bacteria). Many PID guidelines still list tetracycline as an alternative to doxycycline, but one study reports high treatment failure rates when tetracycline was used to treat PID, so women should be aware that doxycycline may be more effective. Both antibiotics are equally effective, however, at treating cervical chlamydial infections.

TREATMENT OF THE WOMAN'S PARTNER: This is extremely important. A woman and her sexual partner must both be treated if treatment is to be effective. This is essential to prevent the woman from being re-infected and having a recurrence of PID. In Sweden, where health authorities have implemented careful follow-up of sex partners since 1977, the rate of repeated episodes of PID has dropped from 22 percent to four percent.

It is important to remember that most partners of women with PID may not have any symptoms, even though they may be infected. For this reason, Health and Welfare Canada strongly recommends that all partners be treated "regardless of the presence or absence of symptoms or signs of infection". (Laboratory Center for Disease Control, PID Treatment Guidelines, 1987).

BED REST: Bed rest is an important part of the treatment of PID. It helps to keep the infection from spreading, insures that the fallopian tubes will not be jolted or jarred and inflamed further, and allows the body time to heal. Bed rest means lying in bed and eliminating all activity (including sex). A woman should not resume sexual relations until follow-up has indicated healing is complete and the sex partner(s) are free from infection.

Special Treatment Considerations

TREATMENT OF ABSCESSES: About ten to fifteen percent of women with PID develop abscesses, which is called complicated PID. Women who have abscesses are more likely to experience long-term health problems, and treatment can be difficult and is controversial.

An abscess is a collection of pus which is formed as part of the body's response to infection. If an abscess has formed, this means that the body's defence against infection has been partially successful. Tissue (like that of a healing wound) forms around the site of infection, isolating it from the rest of the body. However, part of the difficulty in treating abscesses is due to the body's own protective response. The formation of an abscess helps to wall off and isolate infection from the rest of the body, but this also makes penetration by antibiotics more difficult. Also, the environment inside the abscess has a low level of oxygen, so anaerobic bacteria multiply rapidly. These bacteria destroy tissue, reduce circulation, and further block the penetration of antibiotics. Very high levels of bacteria build up within abscesses, and these high levels of bacteria can produce enzymes which prevent many antibiotics from working effectively. As a result, it can sometimes be difficult to kill bacteria inside an abscess.

There is a great deal of controversy about the effective treatment of abscesses. Some believe that surgery should be performed immediately to remove pus and damaged organs, while others believe that IV antibiotics, especially with clindamycin involved, are usually effective. A ten year study of women with abscesses in San Francisco, found that women who were treated with clindamycin were twice as likely to recover and much less likely to experience problems later on than women who were treated with other antibiotics. Although abscesses are a common complication of PID, no specific treatment guidelines have been developed. However, the average length of IV antibiotic treatment reported in the medical research for abscesses is ten to eleven days, sometimes longer.