0071643192.pdf

OBSTETRICS AND GYNECOLOGY

DIAGNOSIS

See Table 12.6.

Transvaginal ultrasound can be used to evaluate for TOA.

TREATMENT

■ Treatment of PID focuses on prompt antibiotic treatment of both N. gon-
orrhoeaeandC. trachomatis.
■ Hospitalization is indicated in pregnant women, immunosuppression,
documented or suspected pelvic abscess, IUD, severe vomiting, or failed
outpatient management.
■ All patients should be referred for HIV and syphilis testing.
■ Treatment of sexual partners is needed.

Outpatient treatment:

1. Ceftriaxone 250 mg IM plusdoxycycline 100 mg PO BID ×14 days

Inpatient treatment:

1. Cefotetan orcefoxitinplusdoxycycline


2. Clindamycin plusgentamycin

COMPLICATIONS

■ Fitz-Hugh-Curtis syndrome.
■ Long-term consequences include infertility, ectopic pregnancy, and
chronic pain.

FITZ-HUGH-CURTIS SYNDROME

An ascending pelvic infection with chlamydia (most common) or gonorrhea
which results in inflammation of the liver capsule or diaphragm.

SYMPTOMS/EXAM

■ Presents with RUQ pain that may mimic cholecystitis
■ May present with referred pain to the right shoulder
■ May or may not be associated with symptoms of PID

TABLE 12.6. Criteria for the Diagnosis of PID

Major criteria needed for PID diagnosis

Lower abdominal pain

Lower abdominal tenderness

CMT

Adnexal tenderness

Additional criteria that increase the specificity of the diagnosis

Fever > 38°C

Abnormal vaginal discharge

+culture for gonorrhea or chlamydia

WBC > 10,000

Elevated CRP or ESR