MANAGEMENT OF ACUTE PELVIC INFLAMMATORY DISEASE

Posted by e-Medical PPT Friday, March 16, 2012
Pelvic inflammatory disease (PID)is a common cause of morbidity and accounts for 1 in 60 GP consultations  by women under the age of 45.
Delays of only a few days in receiving appropriate treatment markedly increase the risk of sequelae, which include:
Infertility,
Ectopic pregnancy and
Chronic pelvic pain.

PID is usually the result of infection ascending from the endocervix causing:
Endometritis,
Salpingitis,
Parametritis,
Oophoritis, 
Tuboovarian abscess and/or
Pelvic peritonitis

While sexually transmitted infections such as :
Chlamydia trachomatis and
Neisseria gonorrhoeae have been identified as causative agents,
Mycoplasma genitalium,
Anaerobes and other organisms may also be implicated.

The following clinical features are suggestive of a diagnosis of PID:
Lower abdominal pain and tenderness
Deep dyspareunia
Abnormal vaginal or cervical discharge
Cervical excitation and adnexal tenderness motion
Fever (> 38°C).

The presence of excess leucocytes on a wet mount vaginal smear is associated with PID, but is also found in women with isolated lower genital tract infection.
Women with suspected PID should be screened for gonorrhoea and chlamydia.
Testing for gonorrhoea and chlamydia in the lower genital tract is recommended,
A positive result strongly supports the diagnosis of PID, but the absence of infection at this site does not exclude PID.
Testing for gonorrhoea should be with an :
Endocervical specimen and tested via culture  (direct inoculation on to a culture plate or transport of the swab to the laboratory within 24 hours)or using a Nucleic acid amplification test (NAAT).
Screening for chlamydia should also be from the endocervix, preferably using a NAAT (e.g. polymerase chain reaction, strand displacement amplification).
Taking an additional sample from the urethra increases the diagnostic yield for gonorrhoea and chlamydia.

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