As the incidence of PID has risen, the rate of hospitalization has fallen. With the increasing availability of outpatient parenteral therapy, hospitalization rates may fall further. There is little data to demonstrate whether outpatient treatment is as effective as inpatient treatment in optimizing long-term clinical outcomes. Admission decisions in the ED are based on severity of illness, likelihood of compliance with outpatient medications, likelihood of major anaerobic infection (IUD, suspected pelvic or tubo-ovarian abscess, or history of recent uterine instrumentation), certainty of diagnosis, coexistent illness and immunosuppression, pregnancy, patient age, and other major fertility issues. Admission is warranted in a number of circumstances (see Table 105-4).
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