Pelvic Inflammatory Disease

GENERAL PRINCIPLES

Pelvic inflammatory disease (PID) is an upper genital tract infection in women, usually preceded by cervicitis. Long-term consequences of untreated PID include chronic pain, increased risk of ectopic pregnancy, and infertility.

DIAGNOSIS

Clinical Presentation

Symptoms can range from mild pelvic discomfort and dyspareunia to severe abdominal pain with fever, which may signal complicating perihepatitis (Fitz-Hugh-Curtis syndrome) or tubo-ovarian abscess.

Diagnostic Testing

• Cervical motion tenderness or uterine or adnexal tenderness, vaginal discharge or friability, and the presence of many white blood cells per low-power field on a saline preparation of vaginal or endocervical fluid are consistent with a diagnosis of PID.

• NAATs or culture of endocervical specimens should be obtained to identify C. trachomatis or N. gonorrhoeae infection.

• All women diagnosed with PID should be screened for HIV infection.

TREATMENT

Severely ill, pregnant, and HIV-infected women with PID should be hospitalized. Patients unable to tolerate oral antibiotics also warrant admission. See Table 16-1.