Treating Infections Appropriately
Early and adequate treatment of patients and their sexual partners is an effective means of minimizing risk for adverse consequences in patients and preventing the community spread of STD. In most clinical instances, as with many other infectious diseases, PID must be treated on the basis of presumptive diagnosis, before the specific diagnosis is confirmed. Treatment based on presumptive diagnosis should
be inexpensive, simple, safe, and effective. "Epidemiological" or preventive treatment also has a major role in PID prevention strategies.63 Based on epidemiological indications, antibiotics should be administered to high-risk women when infection with C trachomatis or gonorrhoeae is considered likely (eg, to the partners of men with
chlamydial or gonococcal infection). This approach interrupts the chain of transmission in the community and reduces the likelihood ofascending genital
infection which might occur between the time of testing and treatment. It also ensures treatment for infected individuals with false-negative laboratory tests and guarantees treatment for those who might not return when notified of positive tests. For example, this philosophy underlies the recommendation for giving tetracycline concurrently
with a penicillin or cephalosporin to patients with confirmed gonococcal infection, since a relatively high proportion are likely to be harboring coexistent
C trachomatis.39" Comprehensive guidelines for the treatment of PID and other STDs are available and should be consistently applied .61