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One in 10 women has PID during her reproductive years. At least one-fourth of women with PID have serious sequelae, such as infertility, ectopic pregnancy or chronic pelvic pain.
PID includes endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.
Microbiology
PID is usually polymicrobial, including both aerobic and nonaerobic bacteria.
Sexually transmissible organisms most frequently implicated include Neisseria gonorrhoeae and Chlamydia trachomatis.
Mycoplasma hominis and Ureaplasma urealyticum have occasionally been isolated. Escherichia coli, streptococcal species, and anaerobes, all part of the normal flora, have been clamidia.
Diagnosis
The diagnosis of PID relies on a high index of suspicion. PID is correctly diagnosed on the basis of clinical and gonorrhea, chlamydia laboratory indicators in only 65% of cases. Therefore, a low threshold for initiating empiric antibiotics is essential.
Risk factors include gonorrhea, chlamydia multiple sex partners, frequent sexual intercourse, and the acquisition of a new sexual partner within the previous 3 months.
PID is characterized by diffuse lower abdominal pain that is often dull and constant, usually bilateral, and less than 2 weeks in duration.
An abnormal vaginal discharge, abnormal bleeding, dysuria, dyspareunia, nausea, vomiting, or fever may be present. PID is more likely to begin during the first half of the menstrual cycle.
Abdominal tenderness, adnexal tenderness, and cervical motion tenderness are the most frequently observed findings.
The presence of symptoms, lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness is sufficient evidence to justify beginning empiric therapy for suspected PID.
| Differential Diagnosis of PID | |
|
Appendicitis
Ectopic pregnancy Hemorrhagic ovarian cyst Ovarian torsion Endometriosis |
Irritable bowel syndrome
Somatization Gastroenteritis Cholecystitis Nephrolithiasis |
Laboratory Evaluation
Laboratory studies may be entirely normal. An elevated leukocyte count does not distinguish PID from other diagnoses.
Cervical cultures for gonorrhea or Chlamydia require 3-7 days for results.
Despite the good specificity of nonculture tests (eg, Chlamydiazyme, Sure Cell Chlamydia), sensitivity remains less than optimal.
Human immunodeficiency virus (HIV) and syphilis testing should be recommended for patients with suspected PID.
Pelvic ultrasonography can detect pelvic abscesses.
Laparoscopy is the "gold standard" for diagnosing PID, and it is recommended when the diagnosis is unclear or when the patient fails to improve.
Treatment
Antibiotic Therapy should be initiated as soon as the diagnosis of PID is suspected, usually before culture.