Brazilian Protocol for Sexually Transmitted infections, 2020: pelvic inflammatory disease

Abstract

Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy.

High prevalence and circulant genotypes of Chlamydia trachomatis in vulnerable university women from four cities in the Brazilian Amazon

“…PID is responsible for 30% of cases of infertility due to tubal factors and 50% of cases of ectopic pregnancies due to tubal occlusion, in addition to being associated with premature birth and spontaneous abortion [13][14][15][16][17][18][19][20][21]. In Brazil, the absence of a monitoring program contributes to the unawareness of this silent epidemic and its recurrent damages, however, the annual number of hospitalizations of women with PID is over 45,000 [22]. The studies have reported prevalence of 4-20.5% in both asymptomatic women [23][24][25][26][27][28][29][30][31] and those seeking gynecological treatment [32][33][34].…”

Comments on Ricardo F Savaris' Letter to the Editor regarding the publication in the JBSTM-Brazilian Protocol for Sexually Transmitted Infections, 2020: “Pelvic Inflammatory Disease”

“…Regarding the use of gentamicin in a single daily dose, as shown in Figure 5 "Pelvic inflammatory disease treatment" in our publication 1 , we emphasize that this is the recommended dosage for in-hospital treatment, as it is at least as effective, or perhaps even more effective, than a fractionated dose. It is of lower cost, requires less intervention, and has lower nephrotoxicity than multiple daily dose regimens.…”

“…We would like to thank Dr. Savaris for his relevant comments on our article (https://doi.org/10.1590/0037-8682-0419-2021) 1 . His letter emphasizes three basic points: 1) diagnostic criteria for pelvic inflammatory disease (PID), 2) benefits in the use of gentamicin as a single dose rather than in two or three daily doses, and 3) suitability of antibiotic usage prior to intrauterine device (IUD) removal or even the need for its removal for the treatment of PID.…”

Up-to-date data on Pelvic Inflammatory Disease

“…It was with great interest that I read the article published by Menezes et al on pelvic inflammatory disease, in a recent publication of the JBSTM 1 , which was a review of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Health Surveillance Secretariat of the Brazilian Ministry of Health. Although it has been reported that the protocol was developed through the selection and analysis of available evidence, followed by discussions with specialists, I would like to share some comments about the "new" evidence provided in the 2020 Brazilian Guidelines.…”

“…For these reasons, the current diagnosis of PID, proposed by the Centers of Disease Control and Prevention (CDC) 3 , has replaced the outdated criteria proposed by Hager et al in 1983 4 and last seen in the CDC 1998 Guidelines for Treatment of STDs 5 . Unfortunately, recent publications from the Brazilian scientific society and the Brazilian government still use the outdated 3 major + 1 minor criteria 1 ),( 6 , despite citing an article with the new CDC criteria 2 . These "new" CDC criteria for PID can be traced back to 2002 7 .…”