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]

  When symptoms do occur, they range from nonspecific complaints, such as abdominal pain to high fever and vomiting. [sutterhealth.org]

• Chills

  Symptoms include pain, cramping, chills, spotting, and nausea. Pelvic Inflammatory Disease (PID) Menu Overview What is pelvic inflammatory disease (PID)? Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. [my.clevelandclinic.org]

  When severe, PID might cause fever, chills, severe lower abdominal or pelvic pain — especially during a pelvic exam — and bowel discomfort. [mayoclinic.org]

  They include pain in the abdomen and lower pelvis, chills, nausea, fever, and a thick and peculiarly odorous vaginal discharge. The major complication of PID is scarring of the fallopian tubes, with infertility often a consequence. [britannica.com]

  But as the infection gets worse, you can have: Pain in your lower belly and pelvis Heavy discharge from your vagina with an unpleasant odor Bleeding between periods Pain during sex Fever and chills Pain when you pee or a hard time going Call your doctor [webmd.com]

  […] 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 and chills [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]

• Abdominal Pain

  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]

  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]

• Abdominal Tenderness

  A greater than 70% decrease in abdominal tenderness score occurred in 89% of 111 patients within 6 weeks of hospital discharge. There were no significant differences between antibiotic treatment groups in any response categories or in toxicity. [ncbi.nlm.nih.gov]

  […] sign: Cervical motion tenderness Adnexal 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 [medchrome.com]

  Fifty women in reproductive age group, who presented with atleast four of the following criteria, were included in the study: history of recurrent lower abdominal pain, presence of lower abdominal tenderness, presence of cervical motion tenderness, presence [ijmm.org]

  Minimum diagnostic criteria for PID include the presence of lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness, although the entire triad may not be noted in early cases of PID. [ahcmedia.com]

  Signs Lower abdominal tenderness (usually bilateral). Mucopurulent cervical discharge and cervicitis seen on speculum examination. Cervical motion tenderness and adnexal tenderness on bimanual vaginal examination. [patient.info]

• Back Pain

  Other symptoms include: fever or chills nausea or vomiting lower back pain need to pee more often abnormal vaginal discharge abnormal vaginal bleeding or spotting between periods Tests and Diagnosis If you have symptoms of PID, your health care provider [smartsexresource.com]

  TENS works at both spinal cord level and higher brain centres to inhibit the transmission of nocioceptors thus relieving the perception of pain. Moist hot pack can be given the low back to relieve pain in the lower back. [physiotherapy-treatment.com]

  Pelvic Inflammatory Disease (PID) Pelvic Inflammatory Disease (PID) Symptoms If a woman has PID, she may have any of these symptoms: Abdominal pain (especially lower abdominal pain) or tenderness Back pain Abnormal uterine bleeding Unusual or heavy vaginal [emedicinehealth.com]

  Cystitis/Pyelonephritis: Patients with significant cystitis may have abdominal and pelvic pain. They may have pain when palpating the bladder during bimanual exam or low back and costovertebral angle (CVA) pain with pyelonephritis. [clinicaladvisor.com]

  […] menstrual bleeding, or purulent vaginal discharge. 1,2,11 Patients may also experience nonspecific symptoms such as lower back pain, nausea, and vomiting. 9 When patients do report symptoms, 36% report mild-to-moderate symptoms and 4% report severe symptoms [uspharmacist.com]

• Low Back Pain

  Electrical stimulation in the form of Transcutaneous electrical nerve stimulation (TENS) to the low back for the symptomatic removal of low back pain can be given. [physiotherapy-treatment.com]

  Cystitis/Pyelonephritis: Patients with significant cystitis may have abdominal and pelvic pain. They may have pain when palpating the bladder during bimanual exam or low back and costovertebral angle (CVA) pain with pyelonephritis. [clinicaladvisor.com]

  Some women also may have low back pain, nausea, and vomiting. 6 It is less common for women to have no symptoms or atypical symptoms, such as right upper quadrant pain from perihepatitis (i.e., Fitz-Hugh–Curtis syndrome). [aafp.org]

  The woman may also experience pain or tenderness, described as aching, cramping, and stabbing, particularly in the lower abdomen, pelvic region, or both. Low back pain may also be present. [medical-dictionary.thefreedictionary.com]

• Flushing

  Douching increases the risk for PID because it destroys the protective normal flora of the vagina, and it could flush bacteria up into the uterus. Risk of reoccurrence of PID is possible with the use of latex condoms. [medical-dictionary.thefreedictionary.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]

  Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms occur, stop having sex and see your doctor soon. [mayoclinic.org]

• 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]

• 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]

  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]

  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]

• 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]

  […] unexplained and untreated abdominal pain are significantly more likely to have tubal infertility than women without such history; therefore caution should be used in dismissing mild symptoms (mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia [pedsinreview.aappublications.org]

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 mean CRP levels decreased by the third day of treatment in all treatment groups, and the decrease by the sixth day of treatment was significant (P less than .05), reflecting the clinical response to therapy faster than did serial ESR determinations [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]

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]