Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory Disease (PID) is an infection of the upper genital tract, which typically affects young sexually active women. Microorganisms attributed to PID spread in three ways: intra-abdominally from the cervix to the endometrium and into the peritoneal cavity; through the lymphatic systems (infection from intra-uterine device); or through the hematogenous system, as with tuberculosis. Some risk factors for PID include: younger then 25 years; young age at first sexual experience; uses of non barrier contraception such as IUD or oral contraceptives; new or multiple partners; history of PID or sexually transmitted infection; and recent IUD insertion(1).
Women typically present with pain of the lower abdominal or pelvic pain. Abnormal vaginal discharge, fever or chills, cramping, dyspareunia, dysuria, and abnormal bleeding may also occur. Some will present with low back pain, nausea and vomiting(1). PID is often difficult to diagnose due to the wide variety of symptoms and many only exhibit mild or vague symptoms. Some women are asymptomatic or go undiagnosed because of failure to recognize mild signs and symptoms. This can be dangerous due to the damaging effects on reproductive health in women. Therefore, a “low threshold” for diagnosis is recommended and includes minimum criteria for clinical diagnosis(2).
Minimum criteria for PID diagnosis:
- Cervical motion tenderness
- Lower abdominal tendernesss
- Adnexal tenderness
- Oral temperature greater then 101 degrees F
- Abnormal vaginal discharge
- Increased white blood cells
- Elevated erythrocyte sedimentation rate
- Elevated C-reactive protein level
- Cervical infection with gonorrhea or Chlamydia(1)
- No migration of pain
- Presence of bilateral abdominal tenderness
- No nausea or vomiting