Two cases of chlamydial pelvic inflammatory disease (PID) are presented. Each was clinically assessed and followed by laboratory methods now available to practitioners. These patients presented with vaginal discharge and chronic abdominal pain. [ncbi.nlm.nih.gov]

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

Classic Presentation Women typically present with bilateral lower abdominal pain, purulent vaginal discharge, or less frequently with abnormal vaginal bleeding. [cdemcurriculum.com]

It may be asymptomatic or may present with discharge or irregular bleeding. [clinicaladvisor.com]

In a significant number of women with pelvic inflammatory disease both bacteria may be present at that same time. However, it is not uncommon for other pathogenic bacteria to be present as well. [virtualmedstudent.com]

• Unsafe Sexual Practices

  It is mostly acquired through unsafe sexual practices and is one of the most serious consequences of sexually transmitted diseases (STD). [drelsa.ae]

  […] partners, avoiding unsafe sexual practices, and routinely using appropriate barrier protection. [emedicine.medscape.com]

• Malaise

  Patients may also present with fever, nausea, vomiting and general malaise, but this is variable and may range from minimally symptomatic to toxic appearing. [cdemcurriculum.com]

• Abdominal Pain

  These patients presented with vaginal discharge and chronic abdominal pain. They initially had positive chlamydia cultures which became negative after treatment with tetracycline. [ncbi.nlm.nih.gov]

  Accompanying symptoms are mild or severe abdominal pain (most notably in the right upper quadrant), enlargement of the liver, and tenderness to abdominal palpation. [news-medical.net]

  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]

  Common symptoms and signs include lower abdominal pain, cervical discharge, and irregular vaginal bleeding. Long-term complications include infertility, chronic pelvic pain, and ectopic pregnancy. [msdmanuals.com]

• Vaginal Discharge

  These patients presented with vaginal discharge and chronic abdominal pain. They initially had positive chlamydia cultures which became negative after treatment with tetracycline. [ncbi.nlm.nih.gov]

  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]

  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]

  To find out if someone has PID, health care providers: ask about sexual activity ask about symptoms do a physical exam, including a pelvic exam test urine (pee) and vaginal discharge for STDs Sometimes more testing is needed. [kidshealth.org]

  They can often vary, but may include: Dull pain in your stomach and lower abdomen and pelvis Green or yellow vaginal discharge, having a distinct and often unpleasant odour Pain during urination Irregular vaginal bleeding Fever or chills Nausea, vomiting [drelsa.ae]

• Pelvic Pain

  Chronic Pelvic Pain. Mayo Clinic. [On-line information]. Available online at http://www.mayoclinic.com/print/chronic-pelvic-pain/DS00571/DSECTION=all&METHOD=print. Accessed March 2009. (Updated 2006 November 13). Pelvic Inflammatory Disease. [labtestsonline.it]

  Determine which women with PID require hospitalization Initial Actions and Primary Survey When a woman of reproductive age presents with vaginal discharge or pelvic pain, a pelvic exam and pregnancy test should always be performed. [cdemcurriculum.com]

  Symptoms include all or any of the following: lower abdominal or pelvic pain deep pain during sexual intercourse fever and feeling unwell an unusual vaginal discharge irregular menstrual bleeding. [nt.gov.au]

  Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that might last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation. Tubo-ovarian abscess. [mayoclinic.org]

• Salpingitis

  Ossler S, Persson K (1982) Epidemiologie and serodiagnostic aspects of chlamydial salpingitis. Obstet Gynecol 59: 206 Google Scholar 18. Paavonen J, Saikku P, Vesterinen E, Aho K(1979) Chlamydia trachomatis in acute salpingitis. [link.springer.com]

  The relative importance of N. gonorrhoeae in these women usually has not been simultaneously determined, but in one report infertility rates after chlamydial salpingitis (23%), gonococcal salpingitis (24%), and nonchlamydial nongonococcal salpingitis [glowm.com]

  (catarrhal) (fallopian tube) (nodular) (pseudofollicular) (purulent) (septic) N70.91 ICD-10-CM Diagnosis Code N70.91 Salpingitis, unspecified 2016 2017 2018 2019 Billable/Specific Code Female Dx chlamydial A56.11 ICD-10-CM Codes Adjacent To A56.11 A54.89 [icd10data.com]

  Salpingitis with endometritis and oophoritis, with or without peritonitis, is often called salpingitis even though other structures are involved. Pus may collect in the tubes (pyosalpinx), and an abscess may form (tubo-ovarian abscess). [msdmanuals.com]

  N70.0 Acute salpingitis and oophoritis N70.1 Chronic salpingitis and oophoritis Hydrosalpinx N70.9 Salpingitis and oophoritis, unspecified N71 Inflammatory disease of uterus, except cervix Includes: endo(myo)metritis metritis myometritis pyometra uterine [apps.who.int]

• Cervical Motion Tenderness

  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]

  Cervical motion tenderness, adnexal or significant abdominal tenderness are signs of PID rather than cervicitis. Patients with PID may or may not have a fever. Other signs of sepsis may be present in severe disease. [clinicaladvisor.com]

  motion tenderness and adnexal or uterine tenderness. [sti.guidelines.org.au]

  On pelvic examination PID is very likely if there is purulent endocervical discharge, cervical motion tenderness (chandelier sign), and adnexal tenderness with bimanual examination. Rectovaginal examination can further support these findings. [pedclerk.bsd.uchicago.edu]

• Adnexal Tenderness

  The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. Cervical motion, uterine, and lower abdominal tenderness may also be present. [cdemcurriculum.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]

  Clinical Diagnostic Criteria for PID One or more of the following minimum criteria must be present on pelvic examination to diagnose PID: Cervical motion tenderness Uterine tenderness Adnexal tenderness The following criteria can improve the specificity [aafp.org]

  On pelvic examination PID is very likely if there is purulent endocervical discharge, cervical motion tenderness (chandelier sign), and adnexal tenderness with bimanual examination. Rectovaginal examination can further support these findings. [pedclerk.bsd.uchicago.edu]

Consequently, a pregnancy test is mandatory in the workup of women of childbearing age who have lower abdominal pain. (See DDx.) [emedicine.medscape.com]

• Chlamydia Trachomatis

  Johannisson G, Löwhagen G-B, Nilsson S (1982) Chlamydia trachomatis and urethritis in men. In: Mårdh P-A, Moller BR, Paavonen J (eds) Chlamydia trachomatis in genital and related infections. [link.springer.com]

  trachomatis Dutch Chlamydia niet-gespecificeerde urethritis, venerische urethritis door Chlamydia trachomatis, Chlamydia trachomatis urethritis, Chlamydia trachomatis urethritis reactie, Chlamydia-urethritis French Urétrite à Chlamydiae, Urétrite à Chlamydia [fpnotebook.com]

  […] of cervix due to Chlamydia trachomatis Infection of peritoneum due to Chlamydia trachomatis Pelvic inflammation with female sterility due to Chlamydia trachomatis PID with female sterility due to Chlamydia trachomatis Index to Diseases and Injuries References [icdlist.com]

  Article Figures/Media 29 References 402 Citing Articles Letters Abstract Background Chlamydia trachomatis is a frequent cause of pelvic inflammatory disease. [nejm.org]

They initially had positive chlamydia cultures which became negative after treatment with tetracycline. Their chlamydia titers increased throughout the course of their disease and treatment. [ncbi.nlm.nih.gov]

Allergy to principal treatment choice Seek specialist advice. [sti.guidelines.org.au]

Other modes of treatment Surgical treatment should be considered in severe cases or where there is clear evidence of a pelvic abscess. [netdoctor.co.uk]

Antibiotic treatment Do not delay antibiotic treatment while waiting for the results of tests if PID is clinically suspected. Delayed treatment increases the risk of long-term complications, such as ectopic pregnancy, infertility and pelvic pain. [patient.info]

Mycoplasma genitalium infection has been associated with treatment failure in some women, and current treatment guidelines do not target this organism. [aafp.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 complications Recurrence rates amongst patients with PID is high. One study of low income AA age 19 showed recurrence rates of 25 and 20 percent, respectively, at 84 months post-treatment. [pedclerk.bsd.uchicago.edu]

Prognosis Getting prompt treatment and follow-up care can cure pelvic inflammatory disease and keep it from causing further problems. [drugs.com]

This article reviews the available literature on the etiology of PID, its clinical manifestations, the pathogenesis and host response to C. trachomatis in PID, diagnosis, PID management, PID-related morbidity, and prevention. [popline.org]

Etiological studies with emphasis on chlamydial infection. Obstet Gynecol 59: 550 PubMed Google Scholar 14. [link.springer.com]

If NAAT is negative, or if another cause is more likely, there are other possible etiologies of cervicitis. [clinicaladvisor.com]

Acute pelvic inflammatory disease: etiology, risk factors and pathogenesis. Clin Obstet Gynecol 1976 Mar;19(1):147-69. (2) McCormack MW. Pelvic Inflammatory Disease. N Engl J Med 1994; 330:115-119 (3) Centers for Disease Control and Prevention. [virtualmedstudent.com]

Epidemiology Every year in the United States PID accounts for 2.5 million outpatient visits, 200,000 hospitalizations, and 100,000 surgical procedures. [pedclerk.bsd.uchicago.edu]

Epidemiology 2000 Sep;11(5):589-97. The Self-Care Advisor:230 The Health Publishing Group 1996. Brigham Narins, Editor. World of Health:872-74. The Gale Group 2000. [consumer.healthday.com]

Epidemiology of acute pelvic inflammatory disease. [glowm.com]

Sexually transmitted diseases, pelvic inflammatory disease, and infertility: an epidemiologic update. Epidemiol Rev 1990 ;12: 199 - 220 3. Westrom L, Wolner-Hanssen P. Pathogenesis of pelvic inflammatory disease. Genitourin Med 1993 ;69: 9 - 17 4. [nejm.org]

Epidemiology The exact prevalence of PID is unknown as it is under-diagnosed and it is also often asymptomatic [ 1 ]. The rate of definite PID diagnosis in primary care is around 280/100,000 person-years [ 2 ]. [patient.info]

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]

Pathophysiology Most cases of PID are presumed to occur in 2 stages. The first stage is acquisition of a vaginal or cervical infection. This infection is often sexually transmitted and may be asymptomatic. [emedicine.medscape.com]

Pathophysiology of abscess formation. Clin Obstet Gynecol 10:93, 1983 56 Moller BR, Freundt EA, Block FT, et al. Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis. [glowm.com]

Recent technological advances should further enhance efforts to prevent chlamydial infection and PID. [ncbi.nlm.nih.gov]

Since PID is the most significant consequence of sexually transmitted bacterial infections, treatments to prevent its long-term sequelae are essential. [popline.org]

Can I prevent chlamydia? The only sure way to prevent chlamydia is to not have vaginal, anal, or oral sex. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading chlamydia. [icdlist.com]

Several pieces of the prevention puzzle have been put in place in recent decades. The prevention of sexually transmitted infections that can cause pelvic inflammatory disease has received deservedly increased attention. [nejm.org]

Back to top Prevention STIs, mainly untreated chlamydia or gonorrhea, is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STIs or by getting early treatment if they do get an STI. [pamf.org]