gynecology and obstetrics
Pelvic Inflammatory Disease (PID)
Diagnosis of PID
High index of suspicion Pelvic examination Cervical tests forN. gonorrhoeaeandC. trachomatis Index of suspicion should be high, particularly in reproductive-age women and girls with risk factors, because clinical presentation is variable and even minimally symptomatic infection may have severe sequelae. PID is suspected when women of reproductive age have lower abdominal pain or cervical or unexplained vaginal discharge, particularly with fever. PID is also considered when irregular vaginal bleeding, dyspareunia, or dysuria is unexplained. A presumptive diagnosis of PID should be made and treatment initiated for sexually active young women and other women at risk for STIs if they are experiencing pelvic or lower abdominal pain, no cause for the illness other than PID can be identified, and if 1 or more of the following 3 minimum clinical criteria are present on pelvic examination: Cervical motion tenderness Uterine tenderness Adnexal tenderness In addition, on pelvic examination, a palpable adnexal mass suggests tubo-ovarian abscess. If PID is suspected, NAAT (nucleic acid amplification test) of cervical specimens forN. gonorrhoeaeandC. trachomatis(which is about 99% sensitive and specific) is done. If NAAT is unavailable, cultures are done. However, upper tract infection is possible even if tests for cervical infection are negative. The white blood cell count may be elevated but is not helpful diagnostically. A pregnancy test should be performed in reproductive-age women. If a patient cannot be adequately examined because of tenderness, imaging studies are done as soon as possible. Ultrasonography is the preferred first-line test. If ultrasound is not available or is inconclusive, other imaging modalities like CT scan may be performed to evaluate for abscess formation, including tubo-ovarian abscess. Other indications for imaging are if an adnexal or pelvic mass is suspected clinically or if patients do not respond to antibiotics within 48 to 72 hours. In such cases, ultrasonography or CT scan is done as soon as possible to exclude tubo-ovarian abscess, pyosalpinx, and disorders unrelated to PID (eg, Ectopic Pregnancy , If the diagnosis is uncertain after ultrasonography or other imaging modalities, or if empiric treatment for PID fails, laparoscopy should be done; purulent peritoneal material noted during laparoscopy is the diagnostic gold standard. If clinical findings suggest PID but the pregnancy test is positive, evaluate for ectopic pregnancy. If a pregnancy test is positive, Ectopic Pregnancy , which can produce similar findings, should be considered. Other common causes of Female Pelvic Pain include Fitz-Hugh-Curtis syndrome may mimic Acute Cholecystitis but can usually be differentiated by evidence of salpingitis during pelvic examination or, if necessary, with ultrasonography. 