Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Defined as inflammation of the upper female genital tract and may include Endometritis Salpingitis Tubo-ovarian abscess Pelvic peritonitis Predisposing risk factors include Multiple sexual partners Younger age of initiating sexual intercourse Prior history of PID Lack of condom use Lack of protective antibody from previous exposure to sexually transmitted organisms and cervical ectopy contribute to the development of PID +++ General Considerations ++ Most common gynecologic disorder necessitating hospitalization for female patients of reproductive age in the United States Incidence is highest in teenage girls Causative agents Neisseria gonorrhoeae Chlamydia Anaerobic bacteria that reside in the vagina Genital mycoplasmas +++ Clinical Findings +++ Symptoms and Signs ++ Patients typically have lower abdominal pain, pelvic pain, or dysuria Systemic symptoms such fever, nausea, or vomiting may be present Vaginal discharge is variable Cervical motion tenderness, uterine or adnexal tenderness, or signs of peritonitis are often seen Mucopurulent cervicitis is present in 50% of patients Tubo-ovarian abscesses can often be detected by careful physical examination (feeling a mass or fullness in the adnexa) +++ Differential Diagnosis ++ Ectopic pregnancy, threatened or septic abortion, adnexal torsion, ruptured and hemorrhagic ovarian cysts, dysmenorrhea, endometriosis, or mittelschmerz Appendicitis, cholecystitis, hepatitis, gastroenteritis, or inflammatory bowel disease Cystitis, pyelonephritis, or urinary calculi +++ Diagnosis +++ Laboratory Findings ++ Elevated WBCs with a left shift and elevated acute phase reactants (erythrocyte sedimentation rate or C-reactive protein) A positive test for N gonorrhoeae or Chlamydia trachomatis is supportive but not necessary for diagnosis Pregnancy needs to be ruled out because patients with an ectopic pregnancy can present with abdominal pain +++ Diagnostic Procedures ++ Laparoscopy Gold standard for detecting salpingitis Performed if diagnosis is uncertain Helps differentiate PID from an ectopic pregnancy, ovarian cysts, or adnexal torsion Endometrial biopsy should be performed in women undergoing laparoscopy who do not have visual evidence of salpingitis since some women may only have endometritis Pelvic ultrasonography is helpful in detecting tubo-ovarian abscesses, which are found in almost 20% of teenagers with PID Transvaginal ultrasound is more sensitive than abdominal ultrasound +++ Treatment ++ Broad-spectrum antibiotic regimens that can be used for outpatients Ceftriaxone, 250 mg intramuscularly once, plus doxycycline, 100 mg orally twice a day for 14 days, with or without metronidazole, 500 mg orally twice a day for 14 days or Cefoxitin, 2 g intramuscularly once, plus probenecid, 1 g orally as a single dose, plus doxycycline, 100 mg orally twice a day for 14 days, with or without metronidazole, 500 mg orally twice a day for 14 days or Other parenteral third-generation cephalosporin (eg, ceftizoxime or cefotaxime) plus doxycycline, 100 mg orally twice a day for 14 days, ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth