Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Nov 30 2021

Pelvic Inflammatory Disease (PID)

  • 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
Card
1 of 0
Question
1 of 6
Private Note