Purpose of review: The management of pelvic inflammatory disease (PID) has significantly changed during the last two decades. Moreover, some recent bacterial findings have led to recent changes in this management.
Recent findings: Most cases of PID are mild-to-moderate uncomplicated forms that can be treated as outpatients. Apart from Chlamydia trachomatis and Neisseria gonorrhoeae, other pathogens such as Mycoplasma genitalium and bacterial vaginosis (BV)-associated bacteria are playing a significant role in PID and thus must be reckoned with. Moreover, gonococci have increasingly become resistant to the majority of antibiotics. This has led to a universal recommendation to treat N. gonorrhoeae infections with ceftriaxone. A few recent clinical trials have shown that quinolones and azithromycin (with metronidazole) are the best therapeutic options to treat uncomplicated PID.
Summary: The management of PID nowadays must take into account the role of pathogens such as M. genitalium, BV-associated bacteria and multiresistant gonococci.