Pelvic inflammatory disease PID includes an array of infectious processes that damage the endometrium, fallopian tubes, ovaries, and pelvic peritoneum. Because of emerging resistance, routine use of quinolones is no longer recommended for pelvic inflammatory disease to provide empiric coverage for gonorrhea. Intrauterine devices pose no increased risk of pelvic inflammatory disease beyond the first 20 days postinsertion.
Intrauterine devices do not need to be removed if the patient with pelvic inflammatory disease is clinically improving within 48 to 72 hours of initiation of antibiotics. Risk factors for PID include age younger than 25 years, new or multiple sex partners, unprotected sexual intercourse, intercourse with a symptomatic partner, young age at onset of sexual activity younger than 15 years , or a history of STIs or PID.
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Damage to the epithelium by infection typically Chlamydia trachomatis or N. A variety of microbes have been isolated in PID. PID is often underdiagnosed because of the wide variation and severity of symptoms. Many women with tubal factor infertility have histologic evidence of PID despite having no previous diagnosis. Fever may also occur, but it is not the dominant symptom. Right upper quadrant pain that is worse with movement and breathing is caused by inflammation and adhesions of the liver capsule, such as in perihepatitis i.
The diagnosis of PID is clinical, with imaging and more invasive studies reserved for cases of diagnostic uncertainty or concern for complications e. Most women with PID have evidence of lower genital tract infection, such as mucopurulent discharge or an increase in white blood cells on saline microscopy i.
Adding more diagnostic findings increases the specificity of diagnosis, but this comes at the risk of decreasing sensitivity, thereby potentially missing cases of PID. Speculum examination should be performed to identify mucopurulent cervical discharge. Saline microscopy of vaginal discharge may reveal predominant white blood cells, which could indicate coexisting BV and trichomoniasis.
