From the Guidelines
Minimum Diagnostic Criteria for Pelvic Inflammatory Disease (PID)
The minimum diagnostic criteria for Pelvic Inflammatory Disease (PID) in adolescent females include uterine/adnexal tenderness or cervical motion tenderness 1.
- These criteria are essential for initiating empiric treatment, especially in sexually active young women and other women at risk for STDs.
- 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 2, 3, 4 ### Empiric Treatment Empiric treatment with antibiotics is recommended for patients with suspected PID, and the chosen regimen should provide broad-spectrum coverage of likely pathogens, including N. gonorrhoeae, C. trachomatis, anaerobes, Gram-negative facultative bacteria, and streptococci 2.
- Examples of effective regimens include ceftriaxone 250mg intramuscularly once and doxycycline 100mg orally twice daily for 14 days, or metronidazole 500mg orally twice daily for 14 days.
- It is crucial to note that the treatment should be initiated promptly in patients who meet the minimum diagnostic criteria and have no other identifiable cause for their symptoms, to prevent long-term complications such as tubal infertility and ectopic pregnancy 1.
From the Research
Minimum Diagnostic Criteria for Pelvic Inflammatory Disease (PID)
The minimum diagnostic criteria for PID in an adolescent female include:
- Lower abdominal or pelvic pain
- At least one of the following: + Adnexal tenderness + Cervical motion tenderness + Uterine tenderness These criteria are recommended by the Centers for Disease Control and Prevention (CDC) 5, 6.
Clinical Features and Laboratory Findings
Other clinical features that may be suggestive of PID include:
- Bilateral lower abdominal tenderness
- Abnormal vaginal or cervical discharge
- Fever (higher than 38 degrees C)
- Abnormal vaginal bleeding
- Dyspareunia
- Presence of excess leucocytes, elevated erythrocyte sedimentation rate or C-reactive protein 7, 8. Transvaginal ultrasound scanning and magnetic resonance imaging may also be helpful in diagnosing PID 7.
Diagnosis and Treatment
The diagnosis of PID is made primarily on clinical suspicion, and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections who have unexplained lower abdominal or pelvic pain and cervical motion, uterine, or adnexal tenderness on examination 6. Treatment regimens for PID include broad-spectrum antibiotics, including coverage for Neisseria gonorrhoeae and Chlamydia trachomatis 5, 6, 8.