Pelvic Inflammatory Disease

Pelvic Inflammatory Disease

Farhad Aziz, MD

University of Kentucky Department of Emergency Medicine

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1-Minute Review Video

Take Home Points

  1. Consider PID in sexually active females with pelvic pain
  2. Cervical Motion Tenderness
  3. Ceftriaxone, Doxycycline, Metronidazole
  4. Complications: Infertility, Tubo-Ovarian Abscess, Ectopic Pregnancy

Typically Asked Questions

  1. What are the most concerning complications from PID?
  2. What is the treatment for PID?
  3. What is the clinical presentation for a female with PID?

Overview:

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. PID is a sexually transmitted disease and is a common serious infection in adolescents and young adults. Risk factors include Multiple sexual partners, history of prior PID or STD, adolescence or young adulthood, intrauterine device and recent menses. The most common organisms associated with PID are Chlamydia trachomatis and Neisseria gonorrhea.

 Presentation:

The most common presenting symptom for patients suffering from PID is lower abdominal pain. The pain may be worse with movement or intercourse. Other symptoms may include vaginal discharge, vaginal bleeding, fever, malaise, nausea/vomiting, and/or dysuria.

Diagnosis:

Diagnosis of PID is largely based on history and physical exam findings. Labs and imaging are rarely helpful. Common physical exam findings are bilateral lower abdominal pain, mucopurulent cervicitis, and cervical motion tenderness. Patients may also present with right upper quadrant pain. This is concerning for progression to perihepatic inflammation (Fitz-Hugh Curtis Syndrome). Though not highly specific, leukocytosis and elevated ESR and CRP may help aid in the diagnosis of PID. All patients with suspected PID should have a urine pregnancy test and urinalysis performed. Endocervical swab should also be performed to isolate pathogen.

Management:

CDC recommendation for empiric treatment of PID is any sexually active female presenting with pelvic pain and one or more of the following:  uterine tenderness, cervical motion tenderness, and/or adnexal tenderness. Most patients can be treated on an outpatient regimen. Acceptable outpatient management should cover anaerobes, chlamydia and gonorrhea and includes Ceftriaxone (250 mg IM once) or cefoxitin (2 g IM once), Doxycycline ( 100 mg PO BID for 14 days), and Metronidazole (500 mg BID for 14 days). Inpatient therapy is reserved for patients in an immunocompromised state, pregnant, toxic, vomiting (unable to tolerate antibiotics), patients with tubo-ovarian abscess, patients with no follow-up and those who have failed outpatient therapy.

Complications:

Complications from PID can be costly to the female reproductive systems. Important complications to remember include tubo-ovarian abscess, ectopic pregnancy, and infertility. Other complications include chronic pelvic pain perihepatitis. Patients diagnosed with a TOA should be admitted and started on parenteral antibiotics. If they do not have any improvement in 72 hours, surgical intervention may be necessary.

Beyond The Boards

  1. EMRAP: PID
  2. emDOCs: PID

Flashcards

  1. Flashcards: PID

Resources

  1. Shepherd SM, Weiss B, Shoff WH. Pelvic Inflammatory Disease. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.
  2. Rivers CS, Weber DE. Preparing for the Written Board Exam in Emergency Medicine. Vol 1. Milford, OH: Emergency Medicine Educational Enterprises; 2000.

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