Correspondence

Pelvic Inflammatory Disease

N Engl J Med 1994; 330:1689June 9, 1994

Article

To the Editor:

The article by McCormack (Jan. 13 issue)1 makes no mention of the importance of routine screening for syphilis and the human immunodeficiency virus (HIV) in patients with pelvic inflammatory disease. Only two of the four treatment regimens adequately treat syphilis (those that include a full 14 days of doxycycline), and none of the regimens are ideal, since they do not include the drug of choice, penicillin2. In addition, patients with a diagnosis of syphilis need to have repeated Venereal Disease Research Laboratory (VDRL) tests at three and six months to check for a cure2; therefore, it is important to know whether patients have a positive VDRL test or rapid-plasma-reagin test, even if they have incidentally been adequately treated. Knowledge of HIV status gives patient and clinician important information about prognosis, medical treatment, and risk modification. Testing should be arranged in a setting that allows longitudinal follow-up.

Robert C. Reiser, M.D., M.S.
Yale University School of Medicine, New Haven, CT 06510

2 References

1. 1

   McCormack WM. Pelvic inflammatory disease. N Engl J Med 1993;330:115-119
   Full Text | Web of Science

2. 2

   1993 Sexually transmitted diseases treatment guidelinesMMWR Morb Mortal Wkly Rep 1993;42:1-102
   Medline

Author/Editor Response

Dr. McCormack replies:

To the Editor: Dr. Reiser's comments are well taken. Patients who are treated for any sexually transmitted condition should have a nontreponemal antigen test for syphilis performed as part of their evaluation. If the test is positive, evaluation and treatment of syphilis should proceed as outlined in the treatment guidelines provided by the Centers for Disease Control and Prevention.1 All the currently recommended treatments for pelvic inflammatory disease should abort incubating seronegative syphilis. Thus, if the nontreponemal antigen test for syphilis is negative, no further action is required. Similarly, patients treated for pelvic inflammatory disease or any other sexually transmitted infection should be offered a test for antibodies to HIV.

William M. McCormack, M.D.
State University of New York, Brooklyn, NY 11203

1 References

1. 1

   1993 Sexually transmitted diseases treatment guidelinesMMWR Morb Mortal Wkly Rep 1993;42:75-81