PID
Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID) refers to the clinical syndrome
(unrelated to pregnancy or surgery) that results when cervical microorganisms
ascend to the endometrium, fallopian tubes and contiguous pelvic structures.
This produces the inflammatory conditions of
- endometritis
- salpingitils
- pelvic
peritonitis or tubo-ovarian abscess
Microorganisms
PID results from direct canalicular spread of organisms from the endocervix
to the endometrial and fallopian tube mucosa.
Conditions can present with complaints of fever and
lower abdominal pain
Other causes of fever and lower abdominal pain include
- acute appendicitis
- diverticulitis
- ectopic pregnancy
- intraabdominal abscess
secondary to perforation of colon
- colitis (ischemic or infectious)
- mesenteric lymphadenitis, etc.
Minimum clinical criteria needed for the diagnosis of
pelvic inflammatory disease
- The clinical diagnosis of acute PID is imprecise.
- Data indicate that
a clinical diagnosis of symptomatic PID has a positive predictive value (PPV)
for salpingitis of 65%-90% when compared with laparoscopy as the standard.
- The
PPV of a clinical diagnosis of acute PID varies depending on epidemiological
characteristics and the clinical setting, with higher PPV among sexually active
young women and among patients attending STD clinics or from settings with high
rates of gonorrhea or Chlamydia.
- In all settings, however, no single historical,
physical, or laboratory finding is both sensitive and specific for the diagnosis
of acute PID.
Empiric treatment of PID
Empiric treatment of PID should be instituted on the basis of the presence of
all of the following three minimum clinical criteria for pelvic inflammation and
in the absence of an established cause other than PID:
1. lower abdominal tenderness,
2. adnexal tenderness, and
3. cervical motion tenderness.
For women with fever clinical signs, more elaborate diagnostic evaluation is
warranted because incorrect diagnosis and management may cause unnecessary
morbidity. These additional criteria may be used to increase the specificity of
the diagnosis.
Routine criteria for diagnosing PID:
oral temperature >38.3
abnormal cervical or vaginal discharge
elevated erythrocyte sedimentation rate
elevated C-reactive protein
laboratory documentation of cervical infection with N. gonorrhea or
C. trachomatis.
The incidence of PID is 5 to 10 times higher in women with intrauterine
devices than in those not using this form of contraception.
Common pathogens implicated in PID.
Sexually transmitted organisms, especially
- Neisseria gonorrhea
and
- Chylamdia trachomatis, are implicated in the majority of cases;
however, microorganisms that can be part of the vaginal flora, such as
anaerobes,
- Gardinerella vaginalis,
- enteric Gram-negative rods, and
-
Streptococcus agalactiae also can cause PID.
Some experts also believe that Mycoplasma
hominis and Ureaplasma urealyticum are etiologic agents of PID.
Treatment
Antimicrobial agents with activity against gonococci, chlamydia.
trachomatis, and anaerobes are used in the treatment of PID.
Regimens include
-
cefoxitin plus doxycycline
- clindamycin plus gentamicin
- ceftriaxone plus doxycycline
- ciprofloxacin plus clindamycin.