Chapter 150 Pelvic Inflammatory Disease PDF

Chapter 150 Pelvic Inflammatory Disease Pelvic Inflammatory Disease Definition Spectrum of inflammatory disorders of the upper genital tract in women may include: Often asymptomatic Any combination of endometritis, salpingitis, tubo-ovarian abscess (TOA), a...

Chapter 150 Pelvic Inflammatory Disease Pelvic Inflammatory Disease Definition Spectrum of inflammatory disorders of the upper genital tract in women may include: Often asymptomatic Any combination of endometritis, salpingitis, tubo-ovarian abscess (TOA), and pelvic peritonitis Most common reason for gynecologic emergency Leading cause of infertility room visits and hospitalizations Risk Factors Young age less than 25 years Having multiple sexual partners No current or consistent use of contraception Risk Factors for PID Living in an area with a high prevalence of STIs Strong correlation between the incidence of STIs and PID in any given population Other risk factors for PID include penetration of the cervical mucous barrier during medical procedures, including the insertion of an intrauterine contraceptive device, vaginal douching. Cigarette smoking A woman’s risk for PID is decreased if she uses barrier contraception, takes oral contraceptives, or has had a tubal sterilization. Clinical Presentation Often asymptomatic, and remain undiagnosed because of their mild or nonspecific signs and symptoms Symptoms vary based on the pathogen responsible. Fever or chills, cramping, dysuria, low back pain, nausea and vomiting, abnormal vaginal bleeding (postcoital, intermenstrual bleeding) Physical Exam Lower abdominal pain Elev. temp 38.3°C (101°F) Abnormal cervical or vaginal mucopurulent discharge Presence of white blood cells (WBCs) on saline microscopy of vaginal secretions Elevated ECRP Cervical infection with N. gonorrhoeae or C. trachomatis Mucopurulent cervical discharge or WBCs on microscopic evaluation of vaginal fluid  HCG Pelvic US RPR Diagnostics HIV Endometrial biopsy MRI Doppler studies Laparoscopy Differential Diagnosis Ectopic pregnancy Acute appendicitis Ovarian torsion Ovarian cyst Endometriosis Corpus luteum bleeding Pelvic adhesions Benign ovarian tumor IBD IBS Diverticulitis Pyelonephritis Nephrolithiasis Cystitis One or more of the following additional criteria can be used to enhance the specificity of the minimum clinical criteria and support a PID diagnosis: Oral temperature >38.3°C (>101°F) Abnormal cervical mucopurulent discharge or cervical friability Presence of abundant numbers of WBCs on saline microscopy of vaginal fluid Elevated erythrocyte sedimentation rate Elevated C-reactive protein Laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis Management Empirical therapy Broad-spectrum antimicrobial Anaerobic coverage coverage including: Combination therapy is necessary. Imperative to empirically treat sexual partner(s) especially those within 60 days preceding onset of symptoms Health monitoring/Education/Monitoring Common Medications Prescribed for PID  Ceftriaxone 500 mg IM in a single dose*  PLUS  Doxycycline 100 mg orally 2 times/day for 14 days  WITH  Metronidazole 500 mg orally 2 times/day for 14 days  https://www.cdc.gov/std/treatment-guidelines/pid.htm  CDC guidelines per 2021 treatment of PID  More continued…  OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime) PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days *For persons weighing >150 kg (~300 lbs.) with documented gonococcal infection, 1 g of ceftriaxone should be administered. How to educate your patients: What is PID? Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID. Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious condition, in women. 1 in 8 women with a history of PID experience difficulties getting pregnant. You can prevent PID if you know how to protect yourself. This fact sheet answers basic questions about PID. https://www.cdc.gov/std/pid/stdfact-pid.htm You are more likely to get PID if you: Have an STD and do not get treated; Have more than one sex partner; Have a sex partner who has sex partners other than you; Have had PID before; Are sexually active and are age 25 or younger; Douche; Use an intrauterine device (IUD) for birth control. However, the small increased risk is mostly limited to the first three weeks after the IUD is placed inside the uterus by a doctor. Prevention and Reducing the Risks The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do the following things to lower your chances of getting PID: Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results; Using latex condoms the right way every time you have sex. https://www.cdc.gov/std/pid/stdfact-pid.htm