gynecology and obstetrics
Pelvic Inflammatory Disease (PID)
Symptoms and Signs of PID
Pelvic inflammatory disease commonly causes lower abdominal pain, fever, cervical discharge, and abnormal uterine bleeding, particularly during or after menses. In Symptoms and Signs , the cervix is erythematous and friable (bleeds easily). Mucopurulent discharge is common; usually, it is yellow-green and can be seen exuding from the endocervical canal. Lower abdominal pain is usually present and bilateral but may be unilateral, even when both tubes are involved. Pain may also occur in the upper abdomen. Nausea and vomiting are common when pain is severe. Irregular bleeding (caused by endometritis) and/or fever each occur in up to one third of patients. Occasionally, dyspareunia or dysuria occurs. Even women with inflammation that is severe enough to cause scarring have minimal or no symptoms. In the early stages, signs may be mild or absent. Later, cervical motion tenderness, guarding, and rebound tenderness are common. PID due toN. gonorrhoeaeis usually more acute and causes more severe symptoms than that due toC. trachomatis, which can be indolent. PID due toM. genitalium, like that due toC. trachomatis, is also mild and should be considered in women who do not respond to first-line therapy for PID. Fitz-Hugh-Curtis syndrome(perihepatitis that causes upper right quadrant pain) may result from acute gonococcal or chlamydial salpingitis. Infection may become chronic, characterized by intermittent exacerbations and remissions. Atubo-ovarian abscess(collection of pus in the adnexa) develops in about 15% of women with salpingitis. It can accompany acute or chronic infection and is more likely if treatment is late or incomplete. Pain, fever, and peritoneal signs are usually present and may be severe. An adnexal mass may be palpable, although extreme tenderness may limit the examination. The abscess may rupture, causing progressively severe symptoms and possibly septic shock. Hydrosalpinxis fimbrial obstruction and tubal distention with nonpurulent fluid; it is usually asymptomatic but can cause pelvic pressure, chronic pelvic pain, dyspareunia, and/or infertility. Salpingitis may causetubal scarring and adhesions,which commonly result in chronic pelvic pain, infertility, and increased risk of ectopic pregnancy. 