Internal Medicine

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

Pelvic Inflammatory Disease 1147

Other Tests

■Peritoneal fluid analysis: increased WBC, bacteria

■Imaging: ultrasound, CT, MRI – enlarged, fluid-filled fallopian tubes,

tubo-ovarian abscess

differential diagnosis

■Gynecological: ectopic pregnancy, ovarian cyst torsion/rupture,

endometriosis

■GI: acute appendicitis, mesenteric lymphadenitis, IBD

■Urinary: UTI, pyelonephritis, nephrolithiasis and renal colic

management

What to Do First

■Check pregnancy test to rule out ectopic

■Indications for hospitalization: unable to rule out surgical emergen-

cies, pregnancy, immunodeficiency (including HIV), severe illness,

tubo-ovarian abscess, patient unable to tolerate oral regimen, unsuc-

cessful outpatient treatment

■Consider hospitalization for adolescents and patients likely to be

non-compliant

General Measures

■Maintain high index of suspicion for PID and low threshold for treat-

ment

■If present, remove IUD after starting antibiotics

■Report cases to local public health authorities and refer sexual con-

tacts for evaluation and treatment

■Advise patient to abstain from sexual activity during therapy

specific therapy

Indications

■Diagnosis of PID is based on clinical findings

■Treat all sexually active young women that meet minimum criteria:

➣Lower abdominal pain

➣Cervical motion tenderness

➣Adnexal tenderness

■Additional diagnostic criteria:

➣Temperature >38.3◦C (>101◦F)

➣Abnormal cervical or vaginal discharge

➣Presence of mucopus or vaginal WBCs

➣Elevated ESR