Pelvic Inflammatory Disease (PID): Signs and Symptoms

by John Fisher, MD

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    00:01 So what are the clinical features of pelvic inflammatory disease? By and large, you're talking about a clinical diagnosis, and we physicians are rather imprecise in how we make this diagnosis.

    00:20 Our positive predictive value is between 65% and 90% compared with the gold standard of laparoscopy.

    00:32 Furthermore, many episodes go undiagnosed because the women have PID, but they don't have symptoms, or their symptoms are rather mild.

    00:45 So the bottomline is a good physician should have his/her antenna up because the diagnosis may be very, very subtle.

    00:58 As a result, we often need to use empirical treatment.

    01:05 So the classic clinical picture would be a woman who has abdominal pain, right lower quadrant, left lower quadrant, or bilateral lower abdominal pain.

    01:20 And all patients who present like that to an emergency department should have a pelvic examination.

    01:30 And on a pelvic exam, one of the classic finding would be cervical motion tenderness.

    01:36 With the least motion of the cervix, this often produces excruciating pain in the woman being examined.

    01:46 And it would be prudent for the physician doing the pelvic exam to warn the woman that he or she is going to move the cervix, and it's important for the woman to mention whether this is very painful or not.

    02:07 The other thing that you might expect would be white blood cells in vaginal secretions.

    02:13 And if a woman has no white cells in vaginal secretions and no cervical discharge she probably doesn't have PID.

    02:23 However, bacterial vaginosis is a marker, mucopurulent cervicitis, and certainly a test for Neisseria gonorrhoeae or Chlamydia trachomatis is an indication for emperical treatment.

    02:41 Most of the patients have a temperature that is greater than 38 degrees Celsius, but some patients are afebrile.

    02:51 Some ancillary test that we often use would be testing for an elevated erythrocyte sedimetation rate (sed rate) or C-reactive protein.

    03:05 All of these are indications for empirical treatment for PID.

    03:11 When the diagnosis still remains in doubt, or if our empirical regimen, whatever we've chosen, hasn't seem to work, then, that may be an indication for a laparoscopy.

    03:29 And so generally that's for failure of emperical therapy or patients who have a history of PID and negative tests for gonorrhea, chlamydia or bacterial vaginosis.

    03:44 Those are the ones that probably do need a laparoscopy.

    03:51 Besides this the laparoscopy is also used to detect Fitz-Hugh-Curtis syndrome when it finds perihepatitis.

    About the Lecture

    The lecture Pelvic Inflammatory Disease (PID): Signs and Symptoms by John Fisher, MD is from the course Genital and Sexually Transmitted Infections. It contains the following chapters:

    • Pelvic Inflammatory Disease – Signs/Symptoms
    • Empirical Treatment
    • Laparoscopy

    Included Quiz Questions

    1. Salpingitis
    2. Granuloma inguinale
    3. Fitz-Hugh-Curtis syndrome
    4. Chlamydial cervicitis
    5. Lymphogranuloma venereum
    1. If a woman has a clinical diagnosis for pelvic inflammatory disease and has failed empirical treatment
    2. All women with a possible diagnosis of pelvic inflammatory disease
    3. All women with a history of pelvic inflammatory disease
    4. If the patient has cervical motion tenderness and a gram negative intracellular dipplococci on evaluation of vaginal secretions
    5. If a patient has cervical motion tenderness but no white blood cells on microscopic evaluation of vaginal secretions
    1. Bilateral lower abdominal pain with out any white blood cells seen on evaluation of vaginal secretions
    2. Cervical motion tenderness
    3. Lower abdominal pain and evidence of bacterial vaginosis
    4. Mucopurulent cervicitis
    5. Lower abdominal pain with positive test for gonorrhea

    Author of lecture Pelvic Inflammatory Disease (PID): Signs and Symptoms

     John Fisher, MD

    John Fisher, MD

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