Pelvic inflammatory disease: Difference between revisions
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**Salpingitis, endometritis, myo/parametritis, oophoritis
**Salpingitis, endometritis, myo/parametritis, oophoritis
***Perihepatitis ([[Fitz-Hugh-Curtis]]) is caused by lymphatic spread
***Perihepatitis ([[Fitz-Hugh-Curtis]]) is caused by lymphatic spread
***[[Tubo-ovarain abscess]] is caused by direct extension
***[[Tubo-ovarian abscess]] is caused by direct extension
*Most common serious infection in women aged 16 to 25 years
*Most common serious infection in women aged 16 to 25 years
**Most common cause of death is rupture of a [[tubo-ovarian abscess]]
**Most common cause of death is rupture of a [[tubo-ovarian abscess]]

Revision as of 06:14, 14 May 2015

Background

  • Pelvic Inflammatory Disease (PID) comprises spectrum of infections of the upper reproductive tract:
  • Most common serious infection in women aged 16 to 25 years
  • Begins as cervicitis with GC or chlamydia that may progress to polymicrobial infection
    • Initial lower tract infection may be asymptomatic

Clinical Features

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)

Differential Diagnosis

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Diagnosis

Work-Up

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

Imaging

  • Pelvic U/S
    • Ultrasound sensitivity may be as low as 56% and specificity of 85% [2]
  • CT

CDC Empiric Diagnosis 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

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

IUD

  • 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. ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. ↑ 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
  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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