We need you! See something you could improve? Make an edit and help improve WikSM for everyone.
Pelvic Inflammatory Disease
From WikiSM
Contents
Other Names
- PID
- Pelvic Inflammatory Disease
Background
- This page refers to pelvic inflammatory disease (PID)
History
Epidemiology
- 10-15% of women with Neisseria gonorrhoeae or Chlamydia trachomatis will go on to develop PID [1]
- Often affects young, sexually active females aged 15-25
- Incidence has been decreasing secondary to early identification and treatment and prevention, however subclinical PID remains difficult to diagnose
Introduction
- Upper genital tract infection in females, usually ascending from the lower genital tract
- Majority (85%) of cases in women are secondary to sexually transmitted infection
- Infection by above listed bacteria in the lower genital tract may ascend through the cervix into the upper genital tract
- Inflammation and scarring of the upper genital tract (uterus, fallopian tubes, ovaries) can ensue
- Inflammation and scarring specifically of the Fallopian tubes may result in infertility
Microbiology
- Most common bacteria isolated are Neisseria gonorrhoeae and/or Chlamydia trachomatis
- Other bacteria isolated: Mycoplasma genitalium, Peptostreptococcus species, Bacteroides species
Risk Factors
- Unprotected intercourse
- Intercourse with multiple partners
- Untreated sexually transmitted infection
- Intrauterine device placement
Differential Diagnosis
- Ectopic pregnancy
- Pelvic venous congestion syndrome
- Appendicitis
- Endometriosis
- Ovarian torsion
- Ruptured ovarian cyst
- Urinary tract infection/cystitis
- Cervicitis
Clinical Features
History
- Abdominal pain may be insidious in onset
- May have history of untreated or unidentified sexually transmitted infection
- Abdominal pain is usually in the lower abdomen/pelvis
- Dyspareunia is a common complaint
- Abdominal pain may be associated with vaginal discharge, abnormal vaginal bleeding, or dysuria
- Systemic symptoms such as fever, nausea, vomiting can be present
- History of recent IUD placement
Physical Exam
- Abdominal tenderness to palpation in lower quadrants (right and/or left may be tender)
- Rebound, guarding, rigidity usually not present and may clue you into an alternative diagnosis (ectopic pregnancy)
Pelvic Exam
- Should be performed in all females with lower abdominal pain or suspected PID
- Evaluate for discharge, usually purulent and foul-smelling if present
- Evaluate for genital lesions (may be multiple sexually transmitted infections present
- Evaluate the cervix for friability or bleeding with cotton-tip applicator
- Bi-manual exam to evaluate for cervical motion tenderness (Chandelier Sign)
Evaluation
- PID is a clinical diagnosis
- Labs such as CBC, CMP, UA with microscopy can aid in identification of other causes of abdominal pain
- Urine pregnancy test should be obtained in all females of child-bearing age with lower abdominal pain to rule-out ectopic pregnancy
- Cervical/vaginal swabs with pelvic exam - Gonococcal, Chlamydial, Trichomoniasis testing
- Negative results do not exclude the diagnosis of PID [1]
- Consider HIV and syphilis co-testing as well
- Transvaginal pelvic ultrasound to identify complications such as tubo-ovarian abscess or identify ectopic pregnancy
Classification
- N/A
Management
- Early identification and treatment based on clinical suspicion helps decrease risk of complications
Outpatient Treatment
- Doxycycline 100mg PO twice daily x14 days PLUS
- Ceftriaxone 500mg IM once OR
- Cefoxitin 2g IM with probenecid 1g PO once OR
- Another 3rd generation cephalosporin that is given IV or IM
- Add metronidazole 500mg PO twice daily x14 days if recent IUD insertion
- Remove IUD to prevent recurrent infection
Inpatient Treatment
- Cefotetan 2g IV every 12hrs PLUS doxycycline 100mg PO every 12hrs OR
- Cefoxitin 2g IV every 6hrs PLUS doxycycline 100mg PO every 12hrs OR
- Clindamycin 900mg IV every 8hrs PLUS gentamicin 3-5mg/kg IV daily[1]
Rehab and Return to Sport
Rehab
- Not applicable
Return to Sport/Work
- Athlete can usually return to play after completing antibiotic treatment unless systemically ill
Prognosis and Complications
Prognosis
- Most patients do well if treated early and correctly
Complications
- Complications can occur even with appropriate antibiotic treatment
- Delayed or lack of treatment was found to lead to worse outcomes across the board
- Some associated complications include ectopic pregnancy (7.8%), recurrent PID, infertility (5-fold increase), chronic abdominal or pelvic pain (33.3%)[1]
- Untreated infection may lead to tubo-ovarian abscess formation requiring removal of Fallopian tube/ovary or drainage of abscess, thus increasing infertility
See Also
References
- ↑ 1.0 1.1 1.2 1.3 Jennings LK, Krywko DM. Pelvic Inflammatory Disease. [Updated 2023 March 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499959/