[Prevention of postoperative or associated of care pelvic inflammatory diseases. Is there a need for antibiotic prophylaxis for first trimester surgical-induced abortion to prevent pelvic inflammatory diseases? CNGOF good practice points]. / Prévention des infections génitales hautes postopératoires ou associées aux soins. Faut-il proposer une antibioprophylaxie lors des interruptions volontaires de grossesse chirurgicales pour prévenir les infections génitales hautes ? Conseils de bonne pratique du CNGOF.

ABSTRACT

Antibiotic prophylaxis is not recommended during surgical induced abortions. Systematic screening for Chlamydia trachomatis and Neisseria gonorrheae infection by polymerase chain reaction (PCR) on a vaginal sample is recommended before any surgical abortion. Moreover, the bacteriological result should be available before the abortion so that antibiotic treatment effective against the identified bacteria, if any, can be proposed before the procedure. The absence of bacteriological result on the day of the abortion must not, however, delay the procedure. If screening is positive for a sexually transmitted infection (STI), and the bacteriological result is only available after the abortion, it is recommended that antibiotic treatment start as soon as possible. The first-line antibiotic treatment is ceftriaxone 500mg in a single dose by the intramuscular route for N. gonorrheae, doxycycline 200mg per day orally for 7 days for C. trachomatis and azithromycin 500mg the first day (D1) then 250mg per day from D2 to D4 orally if Mycoplasma genitalium is detected by multiplex PCR. In case of positive screening, antibiotic treatment of the woman's partner(s) is recommended, adapted to the STI agent(s).