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    Pelvic Inflammatory Disease Clinical Presentation - History, Physical Examination

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    Erick Duque
    Pelvic inflammatory disease (PID) often presents with lower abdominal pain and abnormal vaginal discharge in sexually active young women. On physical exam, cervical motion tenderness, uterine tenderness, or adnexal tenderness suggest PID. Risk factors include multiple sex partners, young age of first intercourse, and recent IUD insertion. Untreated PID can cause serious complications so clinicians are urged to maintain a low threshold for diagnosis and treatment when PID criteria are present.

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    Pelvic Inflammatory Disease Clinical Presentation - History, Physical Examination

    Uploaded by

    Erick Duque
    15 views2 pages
    Pelvic inflammatory disease (PID) often presents with lower abdominal pain and abnormal vaginal discharge in sexually active young women. On physical exam, cervical motion tenderness, uterine tenderness, or adnexal tenderness suggest PID. Risk factors include multiple sex partners, young age of first intercourse, and recent IUD insertion. Untreated PID can cause serious complications so clinicians are urged to maintain a low threshold for diagnosis and treatment when PID criteria are present.

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    Pelvic Inflammatory Disease Clinical Presentation_ History, Physical Examination

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    Pelvic inflammatory disease (PID) often presents with lower abdominal pain and abnormal vaginal discharge in sexually active young women. On physical exam, cervical motion tenderness, uterine tenderness, or adnexal tenderness suggest PID. Risk factors include multiple sex partners, young age of first intercourse, and recent IUD insertion. Untreated PID can cause serious complications so clinicians are urged to maintain a low threshold for diagnosis and treatment when PID criteria are present.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    15 views2 pages

    Pelvic Inflammatory Disease Clinical Presentation - History, Physical Examination

    Uploaded by

    Erick Duque
    Pelvic inflammatory disease (PID) often presents with lower abdominal pain and abnormal vaginal discharge in sexually active young women. On physical exam, cervical motion tenderness, uterine tenderness, or adnexal tenderness suggest PID. Risk factors include multiple sex partners, young age of first intercourse, and recent IUD insertion. Untreated PID can cause serious complications so clinicians are urged to maintain a low threshold for diagnosis and treatment when PID criteria are present.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    2017­6­1 Pelvic 

    Inflammatory Disease Clinical Presentation: History, Physical Examination

    Pelvic Inflammatory Disease Clinical
    Presentation
    Updated: Jan 09, 2017
    Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Nicole W
    Karjane, MD  more...

    PRESENTATION

    History
    The classic patient at high risk for pelvic inflammatory disease (PID) is a menstruating woman
    younger than 25 years who has multiple sex partners, does not use contraception, and lives in an
    area with a high prevalence of sexually transmitted infections (STIs). Young age at first intercourse is
    also a risk factor for PID. Use of an intrauterine device (IUD) for contraception confers a relative risk of
    2.0­3.0 for the first 4 months following insertion, but risk subsequently decreases to baseline. Follow­
    up is recommended within the first month after IUD insertion.

    Women who are not sexually active have a very low incidence of upper genital tract infection, as do
    women who have undergone total abdominal hysterectomy. Bilateral tubal ligation (BTL) does not
    provide protection against PID; however, patients who have had BTL may have delayed and milder
    forms of the disease.

    Depending on the severity of the infection, patients with PID may be minimally symptomatic or may
    present with toxic symptoms of fever (temperature 38° C [100.4° F] or higher), nausea, vomiting, and
    severe pelvic and abdominal pain. Gonococcal PID is thought to have an abrupt onset with more toxic
    symptoms than nongonococcal disease. Gonorrhea­ and chlamydia­associated infections are more
    likely to cause symptoms toward the end of menses and in the first 10 days following menstruation.

    Lower abdominal pain is usually present. The pain is typically described as dull, aching or crampy,
    bilateral, and constant; it begins a few days after the onset of the last menstrual period and tends to
    be accentuated by motion, exercise, or coitus. Pain from PID usually lasts less than 7 days; if the pain
    lasts longer than 3 weeks, the likelihood that PID is the correct diagnosis declines substantially.

    Abnormal vaginal discharge is present in approximately 75% of cases. Unanticipated vaginal
    bleeding, often postcoital, is reported in about 40% of cases. [55] Temperature higher than 38°C (found
    in 30% of cases), nausea, and vomiting manifest late in the clinical course of the disease.

    Physical Examination
    Because of the potential serious complications of untreated PID and the endemic prevalence of the
    infection, the Centers for Disease Control and Prevention (CDC) has adopted an approach designed
    to maximize diagnosis by using minimal criteria. The CDC also urges clinicians to maintain a low
    threshold for diagnosis and empiric treatment.

    The CDC recommends instituting empiric treatment of PID when a sexually active young woman who
    is at risk for STI has pelvic or lower abdominal pain, no identifiable cause for her illness other than
    http://emedicine.medscape.com/article/256448­clinical#showall 1/2
    2017­6­1 Pelvic Inflammatory Disease Clinical Presentation: History, Physical Examination

    PID, and, on pelvic examination, 1 or more of the following minimal criteria [6] :

    Cervical motion tenderness
    Uterine tenderness
    Adnexal tenderness

    A temperature higher than 38.3° C (101° F) and the presence of an abnormal cervical or vaginal
    mucopurulent discharge enhance the specificity of the minimum criteria, as do selected laboratory
    tests.

    Rebound lower abdominal tenderness and involuntary guarding may be noted and suggest
    associated peritonitis. The positive predictive value of these findings will vary, depending on the
    prevalence of PID in a given population.

    A large multicenter trial found adnexal tenderness to be the most sensitive physical examination
    finding (sensitivity, 95%). [56] Mucopurulent cervicitis is common and, if absent, has substantial
    negative predictive value. Adnexal fullness or disproportionate unilateral adnexal tenderness may
    indicate the development of a tubo­ovarian abscess (TOA).

    Molander et al found the following 3 variables to be significant predictors of the diagnosis, correctly
    classifying 65% of patients with laparoscopically documented PID [57] :

    Adnexal tenderness
    Fever
    Elevated erythrocyte sedimentation rate (ESR)

    Right upper quadrant tenderness, especially if associated with jaundice, may indicate associated Fitz­
    Hugh−Curtis syndrome. A prospective cohort study in 117 incarcerated adolescents documented a
    4% incidence of Fitz­Hugh−Curtis syndrome in those with mild­to­moderate PID. [58]

    Differential Diagnoses

    http://emedicine.medscape.com/article/256448­clinical#showall 2/2

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