Updated: 11/30/2021

Pelvic Inflammatory Disease (PID)

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
2
0
0
Topic
  • Snapshot
    • A sexually active 14-year-old girl is brought to the emergency department because of acute bilateral lower quadrant abdominal pain. She has a history of multiple sexual partners. Her temperature is 102°F (38.9°C). Bimanual pelvic exam shows cervical exudate and tenderness on cervical motion. Her β-HCG is within normal limits. Sonogram shows thickened fallopian tubes with fluid in the posterior cul-de-sac.
  • Introduction
    • Clinical definition
      • pelvic inflammatory disease (PID) is an infection of the upper female genital tract that is often polymicrobial
        • may include
          • endometritis
          • salpingitis
          • tubo-ovarian abscess
          • pelvic peritonitis
    • Epidemiology
      • incidence
        • US incidence
          • 750,000 cases annually
      • demographics
        • sexually active women
        • 15-29 years of age
      • location
        • upper female genital tract
      • risk factors
        • age < 25 years of age
        • risky sexual behavior
        • earlier age at first intercourse
        • increasing number of sex partners
    • Pathophysiology
      • pathobiology
        • usually polymicrobia
        • likely microbes
          • Neisseria gonorrhoeae
          • Chlamydia trachomatis
          • anaerobes
          • gram-negative rods
          • Streptococcus agalactiae
          • Gardnerella vaginalis
          • Haeomphilus influenza
          • Cytomegalovirus
          • Mycoplasma genitalium
      • pathoanatomy
        • ascending infection of microbes from endocervix to upper genital tract
    • Associated conditions
      • other sexually transmitted diseases (e.g., chlamydia, chancroid, herpes, etc.)
  • Presentation
    • Symptoms
      • may be asymptomatic if subclinical
      • primary symptoms
        • lower abdominal or pelvic pain
        • chills
        • dyspareunia
        • dysuria
        • nausea or vomiting
    • Physical exam
      • inspection
        • fever
        • abnormal cervical discharge or bleeding
        • cervical friability
        • abnormal vaginal odor
        • ecchymosis and swelling
        • diffuse tenderness
        • right upper quadrant tenderness
          • perihepatic space may be involved
      • provocative tests
        • cervical motion tenderness
          • also known as “chandelier test”
        • adnexal tenderness
        • uterine tenderness
  • Imaging
    • Ultrasonography
      • indication
        • if diagnosis is uncertainty with physical exam and clinical history
      • view
        • transvaginal
      • findings
        • thickened fluid-filled tubes
        • with or without free pelvic fluid
        • with or without tubo-ovarian abscess
  • Studies
    • Labs
      • may test positive for sexually transmitted diseases
        • Neisseria gonorrhoeae
        • Chlamydia trachomatis
    • Diagnostic criteria
      • positive physical exam findings
        • uterine tenderness
        • adnexal tenderness
        • cervical motion tenderness
    • Screening tests may include
      • HIV
      • syphilis
      • hepatitis B
      • pap smear
      • hepatitis C (if patient has history of intravenous drug use)
  • Differential
    • Ectopic pregnancy
      • positive pregnancy test
    • Appendicitis
      • PID typically presents with bilateral abdominal tenderness
  • Treatment
    • Medical
      • ceftriaxone plus doxycycline (outpatient)
        • indications
          • clinical findings of PID alone is often enough to indicate treatment of PID
          • uncomplicated PID
          • urethritis
      • cefoxitin plus doxycycline
        • indications for intravenous medication or hospitalization
          • uncertain diagnosis
          • tubo-ovarian abscess
          • failure to respond to outpatient treamtment within 72 hours
      • clindamycin plus gentamicin
        • most potent option for unstable patients and treatment-resistant infections
          • e.g., tubo-ovarian abscess with hemodynamic instability
  • Complications
    • Infertility
      • 15% after one episode of PID
    • Ectopic pregnancy
      • 10x risk after PID
    • Fitz-Hugh-Curtis syndrome
      • clinical definition
        • infection of liver capsule with multiple peritoneal adhesions
      • incidence
        • 10% of women with PID
  • Prognosis
    • May recur
    • Prognostic variable
      • negative
        • salpingitis
        • multiple recurrence
Flashcards (0)
Cards
1 of 0
Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.GN.13.49) A 20-year-old G0 woman presents with 4 days of fever and pelvic pain. The patient has had these symptoms before but not to this extent. Last night, she even experienced an episode of emesis from her discomfort. The patient is a yoga instructor, does not smoke or drink alcohol, is vegan, and is sexually active with both men and women. Her temperature is 102°F (38.9°C), blood pressure is 124/84 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical examination reveals cervical motion tenderness, left adnexal fullness, and the finding in Figure A. Laboratory values are ordered as seen below.

Hemoglobin: 13 g/dL
Hematocrit: 39%
Leukocyte count: 19,500/mm^3 with normal differential
Platelet count: 297,000/mm^3

An ultrasound is performed as seen in Figure B, and she is admitted to the hospital. Of the following choices, which is the most appropriate initial treatment for this patient?

QID: 103412
FIGURES:
1

Cefoxitin, doxycycline, and metronidazole

15%

(6/39)

2

Ceftriaxone and azithromycin

72%

(28/39)

3

Levofloxacin and metronidazole

0%

(0/39)

4

Metronidazole

3%

(1/39)

5

Surgical drainage

5%

(2/39)

M 7 E

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (2)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (9)
Private Note