Skip to Main Content

+

  • • Lower abdominal pain

    • Fever and chills

    • Menstrual disturbances

    • Purulent cervical discharge

    • Cervical and adnexal tenderness

++

Epidemiology

+

  • • Also referred to as salpingitis or endometritis

    • PID is a polymicrobial infection of the upper genital tract

    • Associated with the sexually transmitted organisms Neisseria gonorrhoeae or Chlamydia trachomatis, as well as endogenous organisms including anaerobes, Haemophilus influenza, enteric gram-negative rods, and streptococci

    • Most common in young, nulliparous, sexually active women with multiple partners

    • PID is more likely to occur when there is a history of PID, recent sexual contact, sexual contact with a partner who has a sexually transmitted disease, recent onset of menses, or when an intrauterine device is used for contraception

    • Other risk markers include nonwhite race, frequent douching, and smoking

    • The use of oral contraceptives or barrier methods of contraception are protective

++

Symptoms and Signs

+

  • • Lower abdominal pain

    • Cervical motion tenderness

    • Adnexal discomfort

    • Temperature > 38.3 °C

    • Purulent cervical discharge

    • Menstrual disturbances

    • Right upper quadrant pain (perihepatitis seen in Fitz-Hugh and Curtis syndromes)

++

Laboratory Findings

+

  • • Elevated ESR or C-reactive protein

    • Cervical infection with N gonorrhoeae or C trachomatis

    • Histopathologic evidence of endometritis on endometrial biopsy

    • β-hCG negative

    • Urine microscopic exam will frequently show a few RBCs and WBCs but is culture negative

++

Imaging Findings

+

  • • Transvaginal US demonstrates fluid-filled tubes often with free pelvic fluid in the cul-de-sac and tubo-ovarian complex

+

  • • Acute appendicitis

    • Ectopic pregnancy

    • Septic abortion

    • Hemorrhagic ovarian cysts or tumors

    • Ruptured ovarian cysts or tumors

    • Torsed ovarian cyst or tumor

    • Myoma degeneration

    • Acute enteritis

++

Rule Out

+

  • • Ectopic pregnancy

    • Septic abortion

    • Torsed or hemorrhagic ovarian cyst

+

  • • Thorough pelvic exam

    • Endocervical culture for N gonorrhoeae and C trachomatis

    • CBC

    • Basic chemistries

    • β-hCG

    • Transvaginal US

    • Endometrial biopsy

++

When to Admit

+

  • • Patient clinically toxic

    • When surgical emergencies such as acute appendicitis cannot be ruled out

    • Presence of tubo-ovarian abscess

    • Patient is pregnant

    • Unable to follow or tolerate outpatient antibiotic regimen

    • Failure to clinically respond to outpatient oral antibiotic therapy

    • Patient is immunodeficient

++

When to Refer

+

  • • Patient clinically toxic

    • When surgical emergencies such as acute appendicitis cannot be ruled out

    • Presence of tubo-ovarian abscess

    • Patient is pregnant

    • Patient is immunodeficient

    • Failure to respond to conservative IV antibiotic therapy

+

  • • Early antibiotic therapy against N gonorrhoeae, C trachomatis, and enteric organisms is essential to prevent long-term sequelae

    • Sexual partner should be examined and treated appropriately

    • Outpatient antibiotic therapy is acceptable for uncomplicated cases

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.