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American Family Physician Sep 2019Pelvic inflammatory disease (PID) is an infection of the upper genital tract occurring predominantly in sexually active young women. Chlamydia trachomatis and Neisseria... (Review)
Review
Pelvic inflammatory disease (PID) is an infection of the upper genital tract occurring predominantly in sexually active young women. Chlamydia trachomatis and Neisseria gonorrhoeae are common causes; however, other cervical, enteric, bacterial vaginosis-associated, and respiratory pathogens, including Mycobacterium tuberculosis, may be involved. PID can be acute, chronic, or subclinical and is often underdiagnosed. Untreated PID can lead to chronic pelvic pain, infertility, ectopic pregnancy, and intra-abdominal infections. The diagnosis 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. Mild to moderate disease can be treated in an outpatient setting with a single intramuscular injection of a recommended cephalosporin followed by oral doxycycline for 14 days. Additionally, metronidazole is recommended for 14 days in the setting of bacterial vaginosis, trichomoniasis, or recent uterine instrumentation. Hospitalization for parenteral antibiotics is recommended in patients who are pregnant or severely ill, in whom outpatient treatment has failed, those with tubo-ovarian abscess, or if surgical emergencies cannot be excluded. Treatment does not change in patients with intrauterine devices or those with HIV. Sex partner treatment is recommended; expedited partner treatment is recommended where legal. Prevention of PID includes screening for C. trachomatis and N. gonorrhoeae in all women younger than 25 years and those who are at risk or pregnant, plus intensive behavioral counseling for all adolescents and adults at increased risk of sexually transmitted infections.
Topics: Diagnosis, Differential; Female; Humans; Pelvic Inflammatory Disease; Risk Factors; Severity of Illness Index; Sexually Transmitted Diseases
PubMed: 31524362
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... Oct 1958
Topics: Female; Humans; Pelvic Inflammatory Disease
PubMed: 13586062
DOI: 10.1055/s-0028-1113895 -
Gynecologie, Obstetrique, Fertilite &... May 2019The objective of this literature review is to update the recommendations for clinical practice about the diagnosis of pelvic inflammatory disease (PID), microbiologic... (Review)
Review
The objective of this literature review is to update the recommendations for clinical practice about the diagnosis of pelvic inflammatory disease (PID), microbiologic diagnosis excluded. An adnexal pain or cervical motion tenderness are the signs that allow a positive diagnosis of PID (LE2). Associated signs (fever, leucorrhoea, metrorrhagia) reinforce clinical diagnosis (LE2). In a woman consulting for symptoms compatible with PID, a pelvic clinical examination is recommended (grade B). In cases of suspected PID, hyperleukocytosis associated with a high C-reactive protein suggests a complicated PID or a differential diagnosis such as acute appendicitis (LE3). The absence of hyperleukocytosis or normal CRP does not rule out the diagnosis of PID (LE1). When PID is suspected, a blood test with a blood count and a CRP test is recommended (grade C). Pelvic ultrasound scan does not contribute to the positive diagnosis of uncomplicated PID because it is insensitive and unspecific (LE3). However, ultrasound scan is recommended to look for signs of complicated PID (polymorphic collection) or differential diagnosis (grade C). Waiting for an ultrasound scan to be performed should not delay the start-up of antibiotic therapy. In case of diagnostic uncertainty, an abdominal-pelvic CT scan with contrast injection is useful for differential diagnosis of urinary, digestive or gynaecological origin (LE2). Laparoscopy is not recommended for the unique purpose of the positive diagnosis of PID (grade B).
Topics: Appendicitis; Blood Cell Count; C-Reactive Protein; Diagnosis, Differential; Female; Humans; Laparoscopy; Leukocytosis; Pelvic Inflammatory Disease; Pelvic Pain; Tomography, X-Ray Computed; Ultrasonography
PubMed: 30878687
DOI: 10.1016/j.gofs.2019.03.010 -
Clinica Europea 1965
Topics: Female; Humans; Pelvic Inflammatory Disease
PubMed: 5884394
DOI: No ID Found -
Infectious Diseases in Obstetrics and... 2011
Topics: Female; Humans; Pelvic Inflammatory Disease
PubMed: 22547912
DOI: 10.1155/2011/714289 -
American Family Physician Aug 2023Acute pelvic pain is defined as noncyclic, intense pain localized to the lower abdomen and/or pelvis, with a duration of less than three months. Signs and symptoms are...
Acute pelvic pain is defined as noncyclic, intense pain localized to the lower abdomen and/or pelvis, with a duration of less than three months. Signs and symptoms are often nonspecific. The differential diagnosis is broad, based on the patient's age and pregnancy status and gynecologic vs. nongynecologic etiology. Nongynecologic etiologies include gastrointestinal, urinary, and musculoskeletal conditions. Urgent gynecologic conditions include ectopic pregnancy, ruptured ovarian cyst, adnexal torsion, and pelvic inflammatory disease. Approximately 40% of ectopic pregnancies are misdiagnosed at the presenting visit. Urgent nongynecologic conditions include appendicitis and pyelonephritis. Less urgent etiologies include sexually transmitted infections, pelvic floor myofascial pain, dysmenorrhea, and muscle strain. Approximately 15% of untreated chlamydia infections lead to pelvic inflammatory disease. History and physical examination findings guide laboratory testing. Questions should focus on the type, onset, location, and radiation of pain; timing and duration of symptoms; aggravating and relieving factors; and associated symptoms. Performing a urine pregnancy test or beta human chorionic gonadotropin test is an important first step for sexually active, premenopausal patients. Imaging options should be considered, with transvaginal ultrasonography first, followed by computed tomography. Magnetic resonance imaging can be useful if ultrasonography and computed tomography are nondiagnostic.
Topics: Female; Humans; Pregnancy; Pelvic Inflammatory Disease; Pelvic Pain; Acute Pain; Chorionic Gonadotropin, beta Subunit, Human; Dysmenorrhea; Pregnancy, Ectopic
PubMed: 37590858
DOI: No ID Found -
American Family Physician Apr 2012Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically;... (Review)
Review
Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including chronic pelvic pain, ectopic pregnancy, and infertility. Hospitalization and parenteral treatment are recommended if the patient is pregnant, has human immunodeficiency virus infection, does not respond to oral medication, or is severely ill. Strategies for preventing pelvic inflammatory disease include routine screening for chlamydia and patient education.
Topics: Administration, Oral; Anti-Bacterial Agents; Biopsy; Chlamydia trachomatis; Diagnostic Imaging; Drug Therapy, Combination; Endometrium; Female; Gynecological Examination; Hospitalization; Humans; Infusions, Parenteral; Male; Mass Screening; Medical History Taking; Neisseria gonorrhoeae; Nucleic Acid Amplification Techniques; Pelvic Inflammatory Disease; Pregnancy; Risk Factors; Sexual Partners
PubMed: 22534388
DOI: No ID Found -
Infectious Disease Clinics of North... Dec 1994The pathophysiology of pelvic inflammatory disease (PID) involves an ascending infection of cervicovaginal microorganisms, of which the most important pathogens are... (Review)
Review
The pathophysiology of pelvic inflammatory disease (PID) involves an ascending infection of cervicovaginal microorganisms, of which the most important pathogens are Neisseria gonorrhoeae and Chlamydia trachomatis. The clinician should recognize that not all women with PID will present with abdominal pain and that associated atypical symptoms such as meteorrhagia and dyspareunia should suggest diagnosis. The documentation of lower genital tract inflammation is helpful in making the diagnosis of PID. Treatment with broad spectrum antibiotic regimens is currently recommended. Prevention of sexually transmitted diseases and ascending infection remains of utmost importance to decrease the sequelae, such as tubal factor infertility and ectopic pregnancy associated with PID.
Topics: Female; Humans; Pelvic Inflammatory Disease
PubMed: 7890934
DOI: No ID Found -
The New England Journal of Medicine Jan 1994
Review
Topics: Female; Humans; Pelvic Inflammatory Disease
PubMed: 8259168
DOI: 10.1056/NEJM199401133300207 -
Das Deutsche Gesundheitswesen Jun 1959
Topics: Female; Humans; Infertility; Infertility, Female; Pelvic Inflammatory Disease
PubMed: 13838863
DOI: No ID Found