Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1146 Pelvic Inflammatory Disease

■Epidemiology of PID complicated by imprecise terminology, lack

of well-defined diagnostic criteria, inconsistent disease reporting

requirements, frequency of asymptomatic infection, reliance on cer-

vical rather than upper genital tract cultures, and polymicrobial

nature of PID

Signs & Symptoms

■10–20% of women with gonorrhea (GC) or chlamydia (CT) infections

of the lower genital tract progress to PID

■Subclinical PID occurs in 60% (commonly caused by CT); mild to

moderate in 30–40%; severe in <5%

■Symptoms: lower abdominal pain, vaginal discharge, vaginal bleed-

ing, dysuria, dyspareunia, nausea or vomiting, anorectal symptoms

■Signs: fever, mucopurulent cervical discharge, cervical motion ten-

derness, uterine and adenexal tenderness, adenexal fullness or mass,

abdominal guarding or rebound tenderness; elevated WBC count,

ESR, C-reactive protein (CRP)

tests

Basic Tests: Blood

■WBC count: elevation particularly associated with GC PID

■ESR≥15 mm/hr; elevated C-reactive protein (CRP)

Basic Tests: Other

■Urinalysis: pyuria, hematuria with urethral GC or CT infection

■Vaginal wet mount:≥3 WBC/hpf, sensitive but not specific

Specific Diagnostic Tests

■Gram’s stained endocervical specimen: Positive for GC=intracel-

lular gram negative diplococci within leukocytes,≥10 WBC/hpf

■Non-culture assays for GC and CT: EIA, DFA, DNA probe, nucleic

acid amplification (LCR, PCR)

■Cervical culture for GC or CT; GC/CT co-infection in 20–30%

■Upper genital tract culture: may be positive for GC, CT, and vaginal

flora including anaerobes

■Endometrial biopsy: histologic evidence of endometritis=intraep-

ithelial polymorphonuclear leukocytes (PMNs) and plasma cells;

sensitivity 92% and specificity 87% but may be lower depending on

sampling

■Laparoscopy: “gold standard” but impractical for routine diagnosis;

abnormalities include tubal erythema, swelling, exudate