Pelvic inflammatory disease: Difference between revisions
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==Diagnosis==
==Diagnosis==
===History===
===History===
#[[Pelvic Pain]] (90%)
*[[Pelvic Pain]] (90%)
#Vaginal discharge (75%)
*Vaginal discharge (75%)
#Vaginal and postcoital bleeding (>33%)
*Vaginal and postcoital bleeding (>33%)
#Dysuria, [[fever]], malaise, [[N/V]]
*Dysuria, [[fever]], malaise, [[N/V]]


===Physical Exam===
===Physical Exam===
#CMT
*CMT
#Adnexal tenderness
*Adnexal tenderness
#*Most sensitive finding (Sn ~95%)
**Most sensitive finding (Sn ~95%)
#Mucopurulent cervicitis
*Mucopurulent cervicitis
#*Absence should raise consideration of another dx
**Absence should raise consideration of another dx
#[[RUQ Pain]]
*[[RUQ Pain]]
#*May indicate perihepatic inflammation (particularly w/ [[jaundice]])
**May indicate perihepatic inflammation (particularly w/ [[jaundice]])


===CDC Treatment Criteria===
===CDC Treatment Criteria===
#Woman at risk for [[STIs]]
*Woman at risk for [[STIs]]
#Pelvic or lower abdominal pain
*Pelvic or lower abdominal pain
#No cause for the illness other than PID can be identified
*No cause for the illness other than PID can be identified
#At least one of the following on pelvic exam:
*At least one of the following on pelvic exam:
##CMT
**CMT
##Uterine tenderness
**Uterine tenderness
##Adnexal tenderness.
**Adnexal tenderness.
#Additional criteria that make the dx more likely:
*Additional criteria that make the dx more likely:
##Oral temperature >101° F (>38.3° C)
**Oral temperature >101° F (>38.3° C)
##Abnormal cervical or vaginal mucopurulent discharge
**Abnormal cervical or vaginal mucopurulent discharge
##Pesence of abundant numbers of WBC on saline microscopy of vaginal fluid
**Pesence of abundant numbers of WBC on saline microscopy of vaginal fluid
##Elevated ESR
**Elevated ESR
##Elevated CRP
**Elevated CRP
##Laboratory documentation of cervical infection with [[GC]] or [[chlamydia]]
**Laboratory documentation of cervical infection with [[GC]] or [[chlamydia]]


==Work-Up==
==Work-Up==
#Urine pregnancy
*Urine pregnancy
#Wet mount
*Wet mount
#Endocervical swab (for [[GC]], [[Chlamydia]])
*Endocervical swab (for [[GC]], [[Chlamydia]])
#CBC
*CBC
#ESR/CRP
*ESR/CRP
#Urine culture, analysis (to excl [[UTI]])
*Urine culture, analysis (to excl [[UTI]])


===Imaging===
===Imaging===
#Pelvic U/S
*Pelvic U/S
##Ultrasound sensitivity may be as low as 56% and specificity of 85% <ref>Lee DC, Swaminathan AK. Sensitivity of ultrasound for the diagnosis of tubo-ovarian abscess: a case report and literature review. J Emerg Med.  
**Ultrasound sensitivity may be as low as 56% and specificity of 85% <ref>Lee DC, Swaminathan AK. Sensitivity of ultrasound for the diagnosis of tubo-ovarian abscess: a case report and literature review. J Emerg Med.  
2011 Feb;40(2):170-5. doi: 10.1016 PMID 20466506 </ref>
2011 Feb;40(2):170-5. doi: 10.1016 PMID 20466506 </ref>
#CT
*CT


==Differential Diagnosis==
==Differential Diagnosis==
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==Complications==
==Complications==
#[[Tubo-Ovarian Abscess]]
*[[Tubo-Ovarian Abscess]]
#[[Fitz-Hugh-Curtis]]
*[[Fitz-Hugh-Curtis]]
##Perihepatic inflammation seen only on CT, not US; LFTs are normal
**Perihepatic inflammation seen only on CT, not US; LFTs are normal
##Responds to standard abx regimen
**Responds to standard abx regimen
#Infertility
*Infertility
#[[Ectopic Pregnancy]]
*[[Ectopic Pregnancy]]
#Chronic pelvic pain
*Chronic pelvic pain


==See Also==
==See Also==
Line 90: Line 90:
*[[Pelvic Pain]]
*[[Pelvic Pain]]


== Source ==
==References==
<references/>
<references/>
[[Category:ID]] [[Category:OB/GYN]]
 
[[Category:ID]]  
[[Category:OB/GYN]]

Revision as of 06:06, 14 May 2015

Background

  • Pelvic Inflammatory Disease (PID) comprises spectrum of infections of the upper reproductive tract:
    • Salpingitis, endometritis, myo/parametritis, oophoritis
      • Perihepatitis (Fitz-Hugh-Curtis) is caused by lymphatic spread
      • Tubo-ovarain abscess is caused by direct extension
  • Most common serious infection in women aged 16 to 25 years
    • Most common cause of death is rupture of a tubo-ovarian abscess
  • Begins as cervicitis w/ GC or chlamydia that may progress to polymicrobial infection
    • Initial lower tract infection may be asymptomatic

Diagnosis

History

  • Pelvic Pain (90%)
  • Vaginal discharge (75%)
  • Vaginal and postcoital bleeding (>33%)
  • Dysuria, fever, malaise, N/V

Physical Exam

  • CMT
  • Adnexal tenderness
    • Most sensitive finding (Sn ~95%)
  • Mucopurulent cervicitis
    • Absence should raise consideration of another dx
  • RUQ Pain
    • May indicate perihepatic inflammation (particularly w/ jaundice)

CDC Treatment Criteria

  • Woman at risk for STIs
  • Pelvic or lower abdominal pain
  • No cause for the illness other than PID can be identified
  • At least one of the following on pelvic exam:
    • CMT
    • Uterine tenderness
    • Adnexal tenderness.
  • Additional criteria that make the dx more likely:
    • Oral temperature >101° F (>38.3° C)
    • Abnormal cervical or vaginal mucopurulent discharge
    • Pesence of abundant numbers of WBC on saline microscopy of vaginal fluid
    • Elevated ESR
    • Elevated CRP
    • Laboratory documentation of cervical infection with GC or chlamydia

Work-Up

  • Urine pregnancy
  • Wet mount
  • Endocervical swab (for GC, Chlamydia)
  • CBC
  • ESR/CRP
  • Urine culture, analysis (to excl UTI)

Imaging

  • Pelvic U/S
    • Ultrasound sensitivity may be as low as 56% and specificity of 85% [1]
  • CT

Differential Diagnosis

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Treatment

Antibiotics

  • No sexual activity for 2 weeks;
  • Treat all partners who had sex with patient during previous 60 days prior to symptom onset

Outpatient Antibiotic Options

Inpatient Antibiotic Options

Other

  • No change in treatment if IUD in place (may treat without removal)

Disposition

Admit:

Discharge:

  • 72hr f/u
  • Instruct pt to abstain from sex or adhere strictly to condom use until sx have abated

Complications

See Also

References

  1. ↑ Lee DC, Swaminathan AK. Sensitivity of ultrasound for the diagnosis of tubo-ovarian abscess: a case report and literature review. J Emerg Med. 2011 Feb;40(2):170-5. doi: 10.1016 PMID 20466506
  2. ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  3. ↑ Hayes BD. Trick of the Trade: IV ceftriaxone for gonorrhea. October 9th, 2012 ALiEM. https://www.aliem.com/2012/10/trick-of-trade-iv-ceftriaxone-for/. Accessed October 23, 2018.
  4. ↑ Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
  5. ↑ Ness RB et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002;186:929–37
  6. ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon
  7. ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon
  8. ↑ Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.
  9. ↑ CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm
  10. ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon
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