From the Guidelines
Pelvic Inflammatory Disease (PID) often presents with lower abdominal pain, which can range from mild to severe, and is typically caused by bacteria that move from the vagina or cervix into the reproductive organs, often as a result of sexually transmitted infections like chlamydia or gonorrhea 1. The symptoms of PID can vary greatly in severity, with some women having mild symptoms that develop slowly, while others experience sudden, severe symptoms. Many women experience abnormal vaginal discharge that may have an unpleasant odor, irregular menstrual bleeding, painful urination, and pain during sexual intercourse. Fever, sometimes accompanied by chills, is common. Some women may also experience nausea and vomiting. It's essential to note that some women with PID may have no symptoms at all, which can lead to delayed diagnosis and treatment. The diagnosis of PID should be suspected in sexually active young women and other women at risk for STDs if they present with uterine/adnexal tenderness or cervical motion tenderness, and no other cause(s) for the illness can be identified 1. Additional criteria that support a diagnosis of PID include:
- oral temperature >101 F (>38.3 C)
- abnormal cervical or vaginal mucopurulent discharge
- presence of white blood cells (WBCs) on saline microscopy of vaginal secretions
- elevated erythrocyte sedimentation rate
- elevated C-reactive protein
- laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis 1. Health-care providers should maintain a low threshold for the diagnosis of PID, as the potential for damage to the reproductive health of women even by apparently mild or atypical PID is significant 1. Prompt medical attention is crucial if PID is suspected, as untreated PID can lead to serious complications including chronic pelvic pain, formation of scar tissue, infertility, and increased risk of ectopic pregnancy.
From the Research
Symptoms of Pelvic Inflammatory Disease (PID)
The symptoms of PID can vary, but common symptoms include:
- Abdominal pain and adnexal tenderness 2
- Fever
- Vaginal discharge
- Irregular menstrual bleeding
- Painful urination
- Painful intercourse
Causes of PID
PID is often caused by bacterial infections, such as:
Diagnosis of PID
Diagnosis of PID is based on clinical criteria, including:
- Abdominal pain and adnexal tenderness
- Cervical motion tenderness
- Uterine tenderness
- Adnexal tenderness
- Laboratory tests, such as endometrial biopsy and cultures, may also be used to confirm the diagnosis 2, 4
Treatment of PID
Treatment of PID typically involves antibiotics, such as:
- Ceftriaxone and doxycycline
- Cefoxitin and doxycycline
- Clindamycin and tobramycin
- Metronidazole may also be added to the treatment regimen to provide broader anaerobic coverage 3, 4, 5
- The choice of antibiotic regimen may depend on the severity of the disease, the presence of anaerobic organisms, and the patient's medical history and allergies 6