All three patients presented with an acute abdomen, fever and elevated white blood cell count. Our experience suggests that PID following tubal sterilization is more common than previously described and can present a diagnostic dilemma. [ncbi.nlm.nih.gov]

Non-gonococcal and non-chlamydial PID present as similar to gonococcal disease. [news-medical.net]

• Fever

  Treatment with colchicine for suspected familial Mediterranean fever resulted in resolution of symptoms. [ncbi.nlm.nih.gov]

  PID IUD use Iatrogenic procedures: Endometrial biopsy, Uterine curettage, Hysterosalpingography Protective Factors: Contraceptive: OCPs and Barrier methods Menopausal, pregnant with monogamous partner Symptoms: Lower abdominal and pelvic pain (dull) Fever [medchrome.com]

• Malaise

  I had severe menstrual irregularities, fevers, bleeding between periods, bleeding after intercourse, pains, and general malaise. Several times I was treated with antibiotics, which brought only some temporary relief. [ourbodiesourselves.org]

  Symptoms typically include progressive lower abdominal pain with guarding and rebound tenderness, fever, copious purulent cervical discharge, nausea and vomiting, malaise, urinary urgency and frequency, vaginal itching, and maceration. [medical-dictionary.thefreedictionary.com]

  Peritonitis, tubo‐ovarian abscess, and severe systemic illness (e.g. fever and malaise) are considered severe forms of PID; the other forms of presentation are considered mild or moderate according to the subjective opinion of the examining doctor or [cochranelibrary.com]

• Unsafe Sexual Practices

  The outcome may not be as good if individuals wait too long before treatment and/or continue to engage in unsafe sexual practices. Complications that can occur include: Tubal damage and scarring can result in infertility. [emedicinehealth.com]

  Education should concentrate on strategies to prevent PID and STIs, including reducing the number of sexual partners, avoiding unsafe sexual practices, and routinely using appropriate barrier protection. [emedicine.medscape.com]

• Atrial Septal Defect

  However, of 12 CA groups evaluated, APID was associated with a higher risk only for cardiovascular CAs (adjusted prevalence OR with 95% CI: 2.6, 1.2-5.4) and the observed number of cases with atrial septal defect, type II with maternal APID exposure exceeded [ncbi.nlm.nih.gov]

• Abdominal Pain

  A total of 190 women of reproductive age (age range, 16-49 years; mean age, 29.3 ± 7.6 years) with complaints of non-traumatic acute lower abdominal pain underwent subsequent abdominopelvic CT. [ncbi.nlm.nih.gov]

  Tags: abdominal pain chronic recurrent abdominal pain dysuria Ovarian Torsion sexual transmitted disease Sean M. Fox I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. [pedemmorsels.com]

• Pelvic Mass

  rebound tenderness, lower abdominal/pelvic mass (in the setting of a tuboovarian abscess), cervical excitation tenderness on bimanual examination All women presenting with symptoms and/or signs suggestive of PID should have a pregnancy test performed [hse.ie]

  Key constituents of the physical examination include an abdominal exam (with right upper quadrant palpation), vaginal speculum exam (that includes inspection of the cervix), bimanual exam (to assess cervical motion, adnexal tenderness and pelvic masses [news-medical.net]

  For more complex cases—such as those that involve a pelvic mass, do not respond quickly to antibiotics or when the symptoms and physical exam are equivocal a laparoscopy may be necessary. [cmdrc.com]

  In addition, reduction or elimination of stagnant pelvic fluids and inflammatory pelvic masses were significant as a result of acupuncture therapy. [healthcmi.com]

  An abdominopelvic CT scan showed no abdominal or pelvic masses; pelvic sonography revealed normal ovaries and no free fluid. Electrolytes, white blood cell count and liver enzymes were all within normal limits; a urinalysis was negative. [austinpublishinggroup.com]

• Pelvic Pain

  A history of pelvic inflammatory disease prior to admission was associated with infertility (p = 0.05), chronic pelvic pain (p = 0.03), and pelvic inflammatory disease subsequent to hospitalization (p = 0.06). [ncbi.nlm.nih.gov]

  […] of maximal tenderness shifts medially with repositioning on the left lateral side, etiology is generally gynecologic Complications: Immediate: Pelvic/Generalized peritonitis, Septicemia Late: CDEF C hronic PID C hronic pelvic pain D yspareunia E ctopic [medchrome.com]

• Vaginal Discharge

  The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever ≥ 38.3 degrees C (82.9%). [ncbi.nlm.nih.gov]

  Dyspareunia RUQ pain indicates perihepatitis (Fitz-Hugh-Curtis syndrome) Signs: Vitals: Elevated temperature > 38c Abdominal palpation: Bilateral lower abdominal tenderness Vaginal examination: Purulent vaginal discharge Congested external urethral meatus [medchrome.com]

  Cervical / vaginal discharge Irregular vaginal bleeding Heavy blood loss suggests endometritis Fever (About 1/3 of patients) Cervicitis The cervix will appear red and will bleed easily OFTEN ASYMPTOMATIC! [almostadoctor.co.uk]

• Cervical Motion Tenderness

  The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever ≥ 38.3 degrees C (82.9%). [ncbi.nlm.nih.gov]

  […] for diagnosis Cervical motion tenderness Uterine tenderness Adnexal tenderness The presence of temperature higher than 38.3° C (101° F) and abnormal cervical or vaginal mucopurulent discharge enhance the specificity of the minimum criteria, as do selected [medchrome.com]

  More common presentations include acute pelvic pain (of variable intensity), cervical motion tenderness, vaginal discharge, fever, dyspareunia, and leukocytosis. Right upper quadrant pain from perihepatitis in Fitz-Hugh-Curtis syndrome is possible. [radiopaedia.org]

  Later, cervical motion tenderness, guarding, and rebound tenderness are common. Occasionally, dyspareunia or dysuria occurs. Many women with inflammation that is severe enough to cause scarring have minimal or no symptoms. [merckmanuals.com]

  Motion Tenderness Uterine Tenderness Adnexal Tenderness The following add support for the diagnosis: Fever (>101°F / >38.3°C) Mucopurulent cervical discharge or friability Wet prep with abundant WBC We always consider: Chlamydia trachomatis Neisseria [pedemmorsels.com]

• Adnexal Tenderness

  An optimal set of PID indicators consisted of adnexal tenderness, lower abdominal pain of < one week's duration and an elevated white blood cell count. [ncbi.nlm.nih.gov]

  tenderness Thickening or definite mass Minimum clinical criteria for diagnosis Cervical motion tenderness Uterine tenderness Adnexal tenderness The presence of temperature higher than 38.3° C (101° F) and abnormal cervical or vaginal mucopurulent discharge [medchrome.com]

  Key constituents of the physical examination include an abdominal exam (with right upper quadrant palpation), vaginal speculum exam (that includes inspection of the cervix), bimanual exam (to assess cervical motion, adnexal tenderness and pelvic masses [news-medical.net]

• Dyspareunia

  Retrospective analysis showed that 43 of the women were given outpatient treatment for acute pelvic inflammatory disease because they had low abdominal pain, deep dyspareunia, or unusual vaginal bleeding, or all of these, for less than 2 months in association [annals.org]

  Occasionally, dyspareunia or dysuria occurs. Many women with inflammation that is severe enough to cause scarring have minimal or no symptoms. [merckmanuals.com]

  Factors: Contraceptive: OCPs and Barrier methods Menopausal, pregnant with monogamous partner Symptoms: Lower abdominal and pelvic pain (dull) Fever and chills Nausea and vomiting (indicates peritonitis) Menstrual disturbances Purulent cervical discharge Dyspareunia [medchrome.com]

  Mild symptoms include – lower abdominal/pelvic pain, deep dyspareunia, a change in vaginal discharge, post coital bleeding Severe symptoms include – all of the above and in addition there may be constitutional symptoms, shoulder tip pain, right upper [hse.ie]

  The affected women may also suffer from dyspareunia ( i.e. recurrent or persistent genital pain during or after sexual intercourse), backache and infertility. [news-medical.net]

The patient underwent extensive workup, multiple courses of intravenous and oral antibiotics, and diagnostic laparoscopies, with continued recurrent episodes. [ncbi.nlm.nih.gov]

• Ovarian Mass

  Adnexal masses associated with peritoneal involvement: diagnosis with CT and MRI. Abdominal Radiol. 2017:1-8. Foti PV. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging. 2016:7(1):21-41. Kouijzer IJE. [ijrcog.org]

  Diagnoses such as ovarian masses, endometrial cancer, and colon cancer should be considered. Diagnosis There is no specific lab value, physical examination finding, or imaging study that is diagnostic of PID. [emdocs.net]

The patients were randomly assigned to two treatment groups: 16 women received ciprofloxacin 200 mg b.i.d. iv. for two days, followed by oral administration with 750 mg b.i.d. to complete a 14-day course of treatment. [ncbi.nlm.nih.gov]

This study directly documents the poor fertility prognosis for women with tubal abscess and suggests that women with culture and/or serological evidence of chlamydial infection also have a poor fertility prognosis. [ncbi.nlm.nih.gov]

Besides, our study revealed that endometriosis was related to a poor prognosis of PID and patients with endometriosis had 5.7-fold higher probability of having a poor prognosis. [omicsonline.org]

[…] become prominent due to infection draining in to lymphatics along the course of the gonadal veins MRI May show an ill-defined adnexal mass containing fluid with various signal intensities: T1+C (Gd): wall and surrounding tissues may enhance Treatment and prognosis [radiopaedia.org]

Prognosis and outcome Prognosis and Outcome Approximately 25% of patients diagnosed with acute PID develop long-term sequelae. The risk for sequelae is increased if the patient has recurrent episodes of PID. [clinicaladvisor.com]

In 19 (47.5%) women, the microbial etiology could not be determined (group C). In no case was Neisseria gonorrhoeae isolated. [ncbi.nlm.nih.gov]

Both groups were compared in terms of laboratory, clinical, and epidemiological parameters. RESULTS: Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found. [ncbi.nlm.nih.gov]

Weström L (1986) Epidemiology of pelvic inflammatory disease. In: Ludwig H, Thomsen K (eds) Gynecology and obstetrics. Springer, New York, pp 659–661 CrossRef Google Scholar 31. Kani J, Adler MW (1992) Epidemiology of pelvic inflammatory disease. [link.springer.com]

Acinetobacter spp. as nosocomial pathogens: Epidemiology and resistance features. Saudi J Biologic Sci; 2016. [ijrcog.org]

PIP: This discussion of acute pelvic inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas [ncbi.nlm.nih.gov]

Acute PID increases a woman's risk for recurrent PID, chronic pelvic pain, infertility and ectopic pregnancy. [2] Our concept of etiology and pathophysiology of acute PID has changed considerably over the past few years and as might be expected, treatment [ijmm.org]

This review paper in Obstetrics and Gynecology is an excellent up to date source for PID pathophysiology, diagnosis, treatment, and long-term outcomes.) Eschenbach, DA, Wolner-Hanssen, P, Hawes, SE, Pavletic, A, Paavonen, J, Holmes, KK. [clinicaladvisor.com]

Symptoms manifesting from these responses include an oral temperature >38.3°C (101°F), elevated erythrocyte sedimentation rate or C-reactive protein, or presence of white blood cells on microscopy of vaginal secretions. 1,2,11 Pathophysiology and Diagnosis [uspharmacist.com]

C 28, 29 Pathophysiology The microorganisms that are implicated in PID are thought to spread in three ways: Intra-abdominally, traveling from the cervix to the endometrium, through the salpinx, and into the peritoneal cavity (causing endometritis, salpingitis [aafp.org]

An intensification of educational efforts directed at IV drug-using women in San Francisco is necessary to prevent further increases in the rate of HIV infection and further spread into the heterosexual population. [ncbi.nlm.nih.gov]