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INTRODUCTION

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Pelvic inflammatory disease (PID) comprises a spectrum of infections of the female upper reproductive tract, including endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Neisseria gonorrhoeae and Chlamydiatrachomatis are frequently isolated pathogens; however, many other microorganisms have been associated with PID, including vaginal flora, gram-negative rods, streptococci, and mycoplasmas. Risk factors for PID include age (teenagers are at greatest risk), multiple sexual partners, a new sexual partner within the past 30 days, presence of other sexually transmitted diseases, and intrauterine device insertion within the prior 3 weeks. PID occurs less commonly in pregnancy, but is associated with increased maternal morbidity and preterm labor. Complications of PID include significantly increased risk for ectopic pregnancy, infertility, and chronic pain, even after only a single episode of PID.

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CLINICAL FEATURES

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Clinical diagnosis of PID is complicated due to the wide variation in symptoms and clinical findings. Common presenting complaints include lower abdominal pain (seen in >90%), vaginal discharge (75%), vaginal bleeding, urinary discomfort, fever, nausea, and vomiting. Many women with PID may have nonspecific or very subtle symptoms. Physical exam may show lower abdominal tenderness, cervical motion tenderness, or uterine/adnexal tenderness. Mucopurulent cervicitis is a common finding, and its absence should prompt consideration of alternative causes of the patient's symptoms.

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DIAGNOSIS AND DIFFERENTIAL

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Given the clinical variability in the diagnosis of PID and the potential sequelae of delayed treatment, the United States Centers for Disease Control and Prevention recommends empiric treatment for PID based on the minimal criteria listed in Table 64-1. No single laboratory test is highly sensitive or specific for PID. Laboratory evaluation should include a pregnancy test, wet preparation of vaginal secretions, and DNA probe or culture for N. gonorroheae and Chlamydia trachomatis. Treatment, when indicated, should not be delayed pending test results.

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Table Graphic Jump Location
Table 64-1

Diagnostic Criteria for Pelvic Inflammatory Disease

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The differential diagnosis includes gastroenteritis, diverticulitis, ectopic pregnancy, spontaneous or septic abortion, ovarian cyst, pyelonephritis, and renal colic.

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EMERGENCY DEPARTMENT CARE ...

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