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Pelvic Inflammatory Disease (PID)

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Topic updated on 01/06/16 2:08pm

Snap Shot
  • A sexually active 17-year-old girl is brought to the emergency department because of acute onset of lower quadrant abdominal pain and loss of appetite that has lasted 18 hours. She has no nausea or vomiting. Her temperature is 102F. Bimanual pelvic exam shows cervical exudate and tenderness on cervical motion. There is bilateral lower quadrant tenderness. Her leukocyte count is 21,300. Her β-HCG is within normal limits. A representative finding of this condition on laparoscopy is shown.
Introduction
  • An ascending genital tract infection secondary to cervical or vaginal infections that includes
    • endometritis
    • salpingitis
    • tubo-ovarian abscess (TOA)
    • pelvic peritonitis
  • Causes include
    • polymicrobial with both aerobic and anaerobic pathogens
      • N. gonorrhoeae
      • C. trachomatis
      • non-STD
        • CMV, B. fragilis, and C. perfringens
  • Risk factors
    • high risk sexual behavior
      • e.g. multiple partners and unprotected sex
Presentation
  • Symptoms
    • lower abdominal pain
    • fever
    • vaginal discharge
    • recent menses
    • RUQ pain
      • perihepatic space may be involved
    • patients often think they have appendicitis
  • Physical exam
    • lower abdominal tenderness
    • cervical motion tenderness
      • Chandelier sign 
        • note: patient jumps to chandelier when palpated
    • adnexal tenderness
    • discharge from cervical os
Treatment
  • Medical
    • ceftriaxone and doxycycline
      • covers C. trachomatis and N. gonorrhoeae
Prognosis, Prevention, and Complications
  • Complications
    • infertility
      • most common cause
    • ectopic pregnancy
      • most common cause
    • chronic pelvic pain


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