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## Complete Summary

#### GUIDELINE TITLE

United Kingdom national guideline for the management of pelvic
inflammatory disease.

#### BIBLIOGRAPHIC SOURCE(S)

United Kingdom national guideline for the management of pelvic
inflammatory disease. London (England): British Association for Sexual
Health and HIV (BASHH); 2005. 15 p. \[34 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Association for Genitourinary
Medicine (AGUM), Medical Society for the Study of Venereal Disease
(MSSVD). 2002 national guidelines for the management of pelvic infection
and perihepatitis. London (England): Association for Genitourinary
Medicine (AGUM), Medical Society for the Study of Venereal Disease
(MSSVD); 2002. Various p.

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory and/or
warning information has been released.

-   [July 08, 2008, Fluoroquinolones (ciprofloxacin, norfloxacin,
    ofloxacin, levofloxacin, moxifloxacin,
    gemifloxacin)](http://www.fda.gov/medwatch/safety/2008/safety08.htm#Fluoroquinolone):
    A BOXED WARNING and Medication Guide are to be added to the
    prescribing information to strengthen existing warnings about the
    increased risk of developing tendinitis and tendon rupture in
    patients taking fluoroquinolones for systemic use.

-   [September 11, 2007, Rocephin (ceftriaxone
    sodium)](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Rocephin):
    Roche informed healthcare professionals about revisions made to the
    prescribing information for Rocephin to clarify the potential risk
    associated with concomitant use of Rocephin with calcium or
    calcium-containing solutions or products.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Pelvic inflammatory disease

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation\
Management\
Treatment

#### CLINICAL SPECIALTY

Infectious Diseases\
Obstetrics and Gynecology\
Urology

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To present a national guideline on the management of pelvic infection

#### TARGET POPULATION

Patients (primarily women aged 16 years and older) in the United Kingdom
with pelvic inflammatory disease

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Assessment/Diagnosis**

1.  Assessment of clinical features

2.  Diagnostic procedures

    -   Testing for gonorrhea and chlamydia

    -   Erythrocyte sedimentation rate or C reactive protein

    -   Laparoscopy

    -   Endometrial biopsy

    -   Ultrasound scanning

3.  Differential diagnosis of lower abdominal pain

**Management/Treatment**

1.  Criteria for selecting a treatment regimen

2.  General advice (e.g., rest, appropriate analgesia) and patient
    education

3.  Screening for other sexually transmitted infections

4.  Pregnancy test

5.  Pharmacological intervention

    -   Broad spectrum antibiotic therapy to cover *Neisseria
        gonorrhoeae*, *Chlamydia trachomatis*, and anaerobic infection

        -   Recommended regimens (outpatient, inpatient):

        -   Alternative regimens

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6.  Sexual partner notification, evaluation, and treatment

7.  Follow-up

8.  Surgical management (laparoscopy)

#### MAJOR OUTCOMES CONSIDERED

-   Sensitivity and specificity of diagnostic instruments

-   Long-term sequelae of pelvic inflammatory disease, such as ectopic
    pregnancy, infertility, and pelvic pain

-   Clinical response to treatment

-   Patient compliance with treatment

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Five reference sources were used as the basis for the guidelines.

1.  Medline and Embase Search

    -   1987 to February 2004: The search strategy comprised the
        following terms in the title or abstract: \"pelvic inflammatory
        disease,\" \"adnexitis,\" \"oophoritis,\" \"parametritis,\"
        \"salpingitis,\" or \"adnexal disease.\" 9,884 citations were
        identified.

    -   1963 to 1986: The search strategy comprised the following terms
        in the title or abstract: \"pelvic inflammatory disease,\"
        \"adnexitis,\" \"oophoritis,\" \"parametritis,\"
        \"salpingitis,\" or \"adnexal disease.\" The dataset was then
        limited to AIM journals and human subjects, identifying 2,321
        citations.

2.  2002 Centers for Disease Control and Prevention Sexually Transmitted
    Disease Treatment Guidelines
    ([www.cdc.gov/std/](http://www.cdc.gov/std/))

3.  2003 Royal College of Obstetrics and Gynaecology Green Top
    Guidelines \-- Management of Acute Pelvic Inflammatory Disease
    ([www.rcog.org.uk](http://www.rcog.org.uk/))

4.  Royal College of Obstetrics and Gynaecology Working Group on Pelvic
    Inflammatory Disease Report 1992

5.  Cochrane Collaboration Databases
    ([www.cochrane.org](http://www.cochrane.org/))

Article titles and abstracts were reviewed and, if relevant, the full
text article obtained. Priority was given to randomised controlled trial
and systematic review evidence, and recommendations made and graded on
the basis of best available evidence.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Levels of Evidence**:

**Ia**

-   Evidence obtained from meta-analysis of randomised controlled trials

**Ib**

-   Evidence obtained from at least one randomised controlled trial

**IIa**

-   Evidence obtained from at least one well designed controlled study
    without randomisation

**IIb**

-   Evidence obtained from at least one other type of well designed
    quasi-experimental study

**III**

-   Evidence obtained from well designed non-experimental descriptive
    studies such as comparative studies, correlation studies, and case
    control studies

**IV**

-   Evidence obtained from expert committee reports or opinions and/or
    clinical experience of respected authorities

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Grading of Recommendations**:

**A (Evidence Levels Ia, Ib)**

-   Requires at least one randomised controlled trial as part of the
    body of literature of overall good quality and consistency
    addressing the specific recommendation

**B (Evidence Levels IIa, IIb, III)**

-   Requires availability of well conducted clinical studies but no
    randomised clinical trials on the topic of recommendation

**C (Evidence Level IV)**

-   Requires evidence from expert committee reports or opinions and/or
    clinical experience of respected authorities

-   Indicates absence of directly applicable studies of good quality

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Prior to submission this guideline was distributed to three consultants
in Genitourinary Medicine. They were asked to use the guideline as an
aid to the management of patients presenting with pelvic inflammatory
disease (PID). Their comments were noted and incorporated into the
current document.

Prior to publication, the final draft of the guideline was placed on the
British Association of Sexual Health and HIV (BASHH) Web site and copies
circulated to the Genitourinary Medicine regional audit, Genitourinary
Nurses Association (GUNA), and Society of Health Advisers in Sexually
Transmitted Diseases (SASH) chairs for comment and peer review. After a
period of three months any comments received were reviewed by the
guideline authors and acted on appropriately, before final authorisation
by the Clinical Effectiveness Group (CEG) was given and publication was
undertaken.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (I-IV) and grades of
recommendation (A-C) are repeated at the end of the \"Major
Recommendations\" field.

**Diagnosis**

-   Pelvic inflammatory disease (PID) may be symptomatic or
    asymptomatic. Even when present, clinical symptoms and signs lack
    sensitivity and specificity (the positive predictive value of a
    clinical diagnosis is 65 to 90% compared with laparoscopic
    diagnosis) (Bevan et al., 1995; \"Sexually transmitted diseases
    treatment guidelines,\" 2002; Morcos et al., 1993).

-   Testing for gonorrhoea and chlamydia in the lower genital tract is
    recommended since a positive result supports the diagnosis of PID.
    The absence of infection at this site does not exclude PID however
    (Bevan et al., 1995; \"Sexually transmitted diseases treatment
    guidelines,\" 2002; Morcos et al., 1993).

-   An elevated erythrocyte sedimentation rate (ESR) or C reactive
    protein also supports the diagnosis (Miettinen et al., 1993).

-   Laparoscopy may strongly support a diagnosis of PID but is not
    justified routinely on the basis of cost and the potential
    difficulty in identifying mild intratubal inflammation or
    endometritis and high rates of intra- and inter-observer variation
    in diagnosing PID (Bevan et al., 1995; CDC, 1998; Morcos et al.,
    1993; Molander et al., 2003).

-   Endometrial biopsy and ultrasound scanning may also be helpful when
    there is diagnostic difficulty, but there is insufficient evidence
    to support their routine use at present. The presence of
    histological endometritis is not associated with higher rates of
    infertility, chronic pelvic pain, or recurrent PID (Haggerty et al.,
    2003).

-   The **absence** of endocervical or vaginal pus cells has a good
    negative predictive value (95%) for a diagnosis of PID, but their
    **presence** is non-specific (poor positive predictive value \--
    17%) (Yudin et al., 2003).

The differential diagnosis of lower abdominal pain in a young woman
includes:

-   Ectopic pregnancy - pregnancy should be excluded in all women
    suspected of having PID.

-   Acute appendicitis - nausea and vomiting occur in most patients with
    appendicitis but only 50% of those with PID. Cervical movement pain
    will occur in about a quarter of women with appendicitis (Bongard,
    Landers, & Lewis, 1985; Lewis et al., 1975).

-   Endometriosis - the relationship between symptoms and the menstrual
    cycle may be helpful in establishing a diagnosis.

-   Complications of an ovarian cyst- often of sudden onset

-   Functional pain - may be associated with longstanding symptoms

**Management**

It is likely that delaying treatment increases the risk of long-term
sequelae such as ectopic pregnancy, infertility, and pelvic pain
(\"Sexually transmitted diseases treatment guidelines,\" 2002; Hillis et
al., 1993). Because of this, and the lack of definitive diagnostic
criteria, a low threshold for empirical treatment of PID is recommended.
Broad spectrum antibiotic therapy is required to cover *Neisseria
gonorrhoeae*, *Chlamydia trachomatis*, and a variety of aerobic and
anaerobic bacteria commonly isolated from the upper genital tract in
women with PID (Bevan et al., 1995; Templeton, 1996; \"Sexually
transmitted diseases treatment guidelines,\" 2002).

The choice of an appropriate treatment regimen may be influenced by:

-   Robust evidence on local antimicrobial sensitivity patterns

-   Robust evidence on the local epidemiology of specific infections in
    this setting

-   Cost

-   Patient preference and compliance

-   Severity of disease

*General Advice*

-   Rest is advised for those with severe disease (Evidence level IV,
    Grade C recommendation).

-   Appropriate analgesia should be provided (Evidence level IV, Grade C
    recommendation).

-   Intravenous therapy is recommended for patients with more severe
    clinical disease (Evidence level IV, Grade C recommendation), e.g.,
    pyrexia \>38 degrees C, clinical signs of tubo-ovarian abscess,
    signs of pelvic peritonitis

-   Patients should be advised to avoid unprotected intercourse until
    they and their partner(s) have completed treatment and follow up
    (Evidence level IV, Grade C recommendation).

-   A detailed explanation of their condition with particular emphasis
    on the long term implications for the health of themselves and their
    partner(s) should be provided, reinforced with clear and accurate
    written information (Evidence level IV, Grade C recommendation).

Outpatient therapy is as effective as inpatient treatment for patients
with mild to moderate PID as assessed clinically (Ness et al., 2002).
Admission for parenteral therapy, observation, further investigation,
and/or possible surgical intervention should be considered in the
following situations (\"Sexually transmitted diseases treatment
guidelines,\" 2002; Ross & Stewart, 2003):

-   A surgical emergency cannot be excluded.

-   Lack of response to oral therapy

-   Clinically severe disease

-   Presence of a tubo-ovarian abscess

-   Intolerance to oral therapy

-   Pregnancy

*Further Investigation*

All patients should be offered:

-   A pregnancy test when required to exclude pregnancy

-   Screening for sexually transmitted infections

**Treatment**

The following antibiotic regimens are evidence based.

Intravenous therapy should be continued until 24 hours after clinical
improvement and then switched to oral. Intravenous doxycycline is not
currently licensed in the United Kingdom (UK) but is available from IDIS
world medicines (0208 410 0700).

*Recommended Regimens*

All the recommended regimens are of similar efficacy.

[Outpatient Regimens]{.underline}

-   Intramuscular (i.m.) ceftriaxone 250mg immediately (stat) or i.m.
    cefoxitin 2g stat with oral probenecid 1g followed by oral
    doxycycline 100 mg twice daily (BD) plus metronidazole 400 mg twice
    daily (BD) for 14 days (Level of Evidence Ib, Grade A
    recommendation) (\"Sexually transmitted diseases treatment
    guidelines,\" 2002; Ness et al., 2002; Arrendondo et al., 1997;
    Hemsell et al., 1994; Martens et al., 1993; The \"Comparative
    evaluation,\" 1992; Walker et al., 1993)

-   Oral ofloxacin 400 mg BD ***plus*** oral metronidazole 400 mg BD for
    14 days (Level of evidence Ib, Grade A recommendation) (\"Sexually
    transmitted diseases treatment guidelines,\" 2002; Martens et al.,
    1993; Walker et al., 1993; Wendel et al., 1991; Soper, Brockwell, &
    Dalton, 1992; Peipert et al., 1999).

In both recommended outpatient regimens metronidazole is included to
improve coverage for anaerobic bacteria. Anaerobes are of relatively
greater importance in patients with severe PID, and metronidazole may be
discontinued in those patients with mild or moderate PID who are unable
to tolerate it.

Ofloxacin should be avoided in patients who are at high risk of
gonococcal PID because of increasing quinolone resistance in the UK
(e.g., patient\'s partner has gonorrhoea, clinically severe disease,
sexual contact abroad). Levofloxacin is the L isomer of ofloxacin
(Isaacson et al., 1996) and has the advantage of once daily dosing (500
mg once a day \[OD\] for 14 days). It may provide a more convenient
alternative to ofloxacin but no clinical trials in women with PID have
been published for this agent (\"Sexually transmitted diseases treatment
guidelines,\" 2002).

[Inpatient Regimens]{.underline}

-   intravenous (i.v) cefoxitin 2 g three times daily (TID) plus i.v.
    doxycycline 100 mg BD (oral doxycycline may be used if tolerated)
    followed by oral doxycycline 100 mg BD plus oral metronidazole 400
    mg BD for a total of 14 days (Level of evidence Ib, Grade A
    recommendation) (\"Sexually transmitted diseases treatment
    guidelines,\" 2002; Ness et al., 2002; Hemsell et al., 1994; Martens
    et al., 1993; \"Comparative evaluation,\" 1992; Walker et al., 1993)

-   i.v. clindamycin 900 mg TID plus i.v. gentamicin (2 mg/kg loading
    dose followed by 1.5 mg/kg TID \[a single daily dose of 7 mg/kg may
    be substituted\]) followed by either oral clindamycin 450 mg four
    times daily (QID) for 14 days or oral doxycycline 100 mg BD plus
    oral metronidazole 400 mg BD for 14 days (Level of evidence Ib,
    Grade A recommendation) (\"Sexually transmitted diseases treatment
    guidelines,\" 2002; Hemsell et al., 1994; \"Comparative
    evaluation,\" 1992; Walker et al., 1993).

Gentamicin levels need to be monitored if this regimen is used.

[Alternative Regimens]{.underline}

-   i.v. ofloxacin 400 mg BD plus i.v. metronidazole 500 mg TID for 14
    days (Level of evidence III, Grade B recommendation) (\"Sexually
    transmitted diseases treatment guidelines,\" 2002; Martens et al.,
    1993; Walker et al., 1993; Wendel et al., 1991; Witte et al., 1993)

-   i.v. ciprofloxacin 200 mg BD *plus* i.v. (or oral) doxycycline 100
    mg BD *plus* i.v. metronidazole 500 mg TID for 14 days (Level of
    evidence III, Grade B recommendation) (\"Sexually transmitted
    diseases treatment guidelines,\" 2002; Walker et al., 1993; Heinonen
    et al., 1989)

[Allergy]{.underline}

There is no evidence of the superiority of any one of the suggested
regimens over the others. Therefore patients known to be allergic to one
of the suggested regimens should be treated with an alternative.

[Pregnancy and Breast Feeding]{.underline}

-   In pregnancy PID is associated with an increase in both maternal and
    fetal morbidity; therefore parenteral therapy is advised, although
    none of the suggested evidence-based regimens is of proven safety in
    this situation.

-   There are insufficient data from clinical trials to recommend a
    specific regimen, and empirical therapy with agents effective
    against gonorrhoea, chlamydial, and anaerobic infections should be
    considered, taking into account local antibiotic sensitivity
    patterns (for example, i.m. ceftriaxone plus oral/i.v. erythromycin,
    with the possible addition of i.v metronidazole 500 mg TID in
    clinically severe disease) (Level of evidence IV, Grade C
    recommendation).

-   The risk of giving any of the recommended antibiotic regimens in
    very early pregnancy (prior to a positive pregnancy test) is low,
    with any significant drug toxicity resulting in failed implantation
    (personal communication, UK National Teratology Information
    Service).

*Surgical Management*

-   Laparoscopy may help early resolution of the disease by division of
    adhesions and drainage of pelvic abscesses (Reich & McGlynn, 1987),
    but ultrasound guided aspiration of pelvic fluid collections is less
    invasive and may be equally effective. (Aboulghar, Mansour, &
    Serour, 1995; Corsi et al., 1999)

-   It is also possible to perform adhesiolysis in cases of
    perihepatitis although there is no evidence whether this is superior
    to only using antibiotic therapy.

**Sexual Partners**

-   Current male partners of women with PID should be contacted and
    offered health advice and screening for gonorrhoea and chlamydia.
    Other recent sexual partners may also be offered screening; tracing
    of contacts within a 6-month period of onset of symptoms is
    recommended but this time period may be influenced by the sexual
    history (Level of evidence IV, Grade C recommendation).

-   Partners should be advised to avoid intercourse until they and the
    index patient have completed the treatment course (Level of evidence
    IV, Grade C recommendation).

-   Gonorrhoea diagnosed in the male partner should be treated
    appropriately and concurrently with the index patient (Level of
    evidence IV, Grade C recommendation).

-   Concurrent empirical treatment for chlamydia is recommended for all
    sexual contacts due to the variable sensitivity of currently
    available diagnostic tests (Level of evidence IV, Grade C
    recommendation).

-   If adequate screening for gonorrhoea and chlamydia in the sexual
    partner(s) is not possible, empirical therapy for gonorrhoea and
    chlamydia should be given (Level of evidence IV, Grade C
    recommendation).

**Follow-up**

Review at 72 hours is recommended (\"Sexually transmitted diseases
treatment guidelines,\" 2002), particularly for those with a moderate or
severe clinical presentation, and should show a substantial improvement
in clinical symptoms and signs (Level of evidence IV, Grade C
recommendation). Failure to do so suggests the need for further
investigation, parenteral therapy, and/or surgical intervention.

Further review 4 weeks (Level of evidence IV, Grade C recommendation)
after therapy may be useful to ensure:

-   Adequate clinical response to treatment

-   Compliance with oral antibiotics

-   Screening and treatment of sexual contacts

-   Awareness of the significance of PID and its sequelae

Repeat testing for gonorrhoea or chlamydia is appropriate in those in
whom persisting symptoms, antibiotic resistance pattern (gonorrhoea
only), compliance with antibiotics, and/or tracing of sexual contacts
indicate the possibility of persisting or recurrent infection.

**Definitions**:

The following rating scheme was used for major management
recommendations.

**Levels of Evidence**

**Ia**

-   Evidence obtained from meta-analysis of randomised controlled trials

**Ib**

-   Evidence obtained from at least one randomised controlled trial

**IIa**

-   Evidence obtained from at least one well designed controlled study
    without randomisation

**IIb**

-   Evidence obtained from at least one other type of well designed
    quasi-experimental study

**III**

-   Evidence obtained from well designed non-experimental descriptive
    studies such as comparative studies, correlation studies, and case
    control studies

**IV**

-   Evidence obtained from expert committee reports or opinions and/or
    clinical experience of respected authorities

**Grading of recommendations**

**A (Evidence levels Ia, Ib)**

-   Requires at least one randomised controlled trial as part of the
    body of literature of overall good quality and consistency
    addressing the specific recommendation

**B (Evidence levels IIa, IIb, III)**

-   Requires availability of well conducted clinical studies but no
    randomised clinical trials on the topic of recommendation

**C (Evidence level IV)**

-   Requires evidence from expert committee reports or opinions and/or
    clinical experience of respected authorities

-   Indicates absence of directly applicable studies of good quality

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=8100)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is graded and identified for select
recommendations (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate management of pelvic infection should show a substantial
improvement in clinical symptoms and signs.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   The recommendations in this guideline may not be appropriate for use
    in all clinical situations. Decisions to follow these
    recommendations must be based on the professional judgement of the
    clinician and consideration of individual patient circumstances and
    available resources.

-   All possible care has been undertaken to ensure the publication of
    the correct dosage of medication and route of administration.
    However, it remains the responsibility of the prescribing physician
    to ensure the accuracy and appropriateness of the medication they
    prescribe.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Audit Criteria/Indicators

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

United Kingdom national guideline for the management of pelvic
inflammatory disease. London (England): British Association for Sexual
Health and HIV (BASHH); 2005. 15 p. \[34 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 Aug (revised 2005)

#### GUIDELINE DEVELOPER(S)

British Association for Sexual Health and HIV - Medical Specialty
Society

#### SOURCE(S) OF FUNDING

This guideline was commissioned and edited by the Clinical Effectiveness
Group of the British Association of Sexual Health and HIV, without
external funding being sought or obtained.

#### GUIDELINE COMMITTEE

Clinical Effectiveness Group (CEG)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Authors*: Jonathan D.C. Ross, MB ChB MD FRCP(Edin) FRCP (Lond),
Whittall Street Clinic, Birmingham

*Clinical Effectiveness Group (CEG) Members*: Keith Radcliffe
(Chairman); Imtyaz Ahmed-Jushuf; Mark Fitzgerald; Jan Welch; Guy Rooney;
David Daniels

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The author has not declared any conflict of interest.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Association for Genitourinary
Medicine (AGUM), Medical Society for the Study of Venereal Disease
(MSSVD). 2002 national guidelines for the management of pelvic infection
and perihepatitis. London (England): Association for Genitourinary
Medicine (AGUM), Medical Society for the Study of Venereal Disease
(MSSVD); 2002. Various p.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [British Association for Sexual
Health and HIV Web site](http://www.bashh.org/guidelines).

#### AVAILABILITY OF COMPANION DOCUMENTS

Audit Criteria are available in the [original guideline
document](http://www.bashh.org/documents/118/118.pdf).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on December 8, 2000. The information
was verified by the guideline developer on January 12, 2001. This
summary was updated on August 5, 2002, and on November 1, 2005. The
updated information was verified by the guideline developer on January
19, 2006. This summary was updated by ECRI Institute on October 3, 2007
following the U.S. Food and Drug Administration (FDA) advisory on
Rocephin (ceftriaxone sodium). This summary was updated by ECRI
Institute on July 28, 2008 following the U.S. Food and Drug
Administration advisory on fluoroquinolone antimicrobial drugs.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developers and/or BMJ Publishing Group\'s copyright
restrictions. Reproduction and use of this guideline is permitted
provided that (a) the original content is not changed or edited; and,
(b) any content derived from the original guideline is acknowledged as
that of the author(s) and responsible organizations.

Readers wishing to download and reproduce material for purposes other
than personal study or education should contact BMJ Publishing Group to
seek permission first at <http://www.bmjjournals.com/misc/perm1.shtml>.

### DISCLAIMER

#### NGC DISCLAIMER

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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008