A case of massive exudative hemorrhagic ascites occurring as a serious complication of chronic pelvic inflammatory disease (PID) is presented. The clinical manifestations, simulating diffuse carcinomatosis in a young female patient, are described. [ncbi.nlm.nih.gov]

Case Presentation A 44 year old para 2012 presented to a local emergency room with a three day history of progressive lower abdominal pain and nausea. [austinpublishinggroup.com]

And early presentation for the diagnosis and treatment of pelvic pain should be a key message of all sexual health promotion programs. [theconversation.com]

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

• Pain

  pain symptoms, etc.) and acupuncture related treatment. [ncbi.nlm.nih.gov]

  Treatment Principle Cool Heat Eliminate Dampness Release Stasis Stop pain Herb Formulas Points Clinical Manifestations Cold pain in the lower abdomen in fixed location The pain is ameliorated by warmth Copious, white and thin vaginal discharge Cold body [americandragon.com]

  When they are present they may include : lower abdominal or pelvic pain abnormal vaginal discharge irregular menstrual bleeding fever pain during sexual intercourse painful or increased urination. [theconversation.com]

• Infertility

  Abstract Diagnostic laparoscopy performed during an infertility evaluation identified 80 patients with hydrosalpinges (12% of all laparoscopic examinations performed for infertility). [ncbi.nlm.nih.gov]

  Left untreated, PID can cause infertility, chronic pelvic pain and ectopic pregnancy (where the fetus develops outside the womb, usually in the fallopian tube). The psychological impact of these experiences can be severe. [theconversation.com]

  The findings showed that nearly one-fifth of the subjects were infertile, and 43 percent reported chronic pelvic pain. [livescience.com]

  PID is a major cause of infertility in women of reproductive age. About 20 percent of women who have PID become infertile. In the United States, PID causes an estimated 100,000 cases of female infertility every year. [healthcommunities.com]

  This is when the tubes which allow the egg to travel from the ovary into the uterus are blocked, which is a common cause of female infertility. [medivizor.com]

• Fever

  Alternating chills and fever Red cheeks Wheezing Nervousness Headache Red eyes Dry mouth Anorexia Infertility Abdominal pain Anxiety Spontaneous sweating or night sweats with fever Dry eyes Hypochondriac pain Anorexia Somnolence Insomnia Aching shoulders [americandragon.com]

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

  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]

  Stay in bed until the fever has subsided. Refrain from vigorous pelvic activity (e.g., sex) that can spread the infection and slow healing. [healthcommunities.com]

  PID can cause pelvic pain, abdominal tenderness, vaginal discharge, fever, chills, and pain during urination and sex. Treatment includes antibiotics, especially if you have a STD. [hopkinsmedicine.org]

• Inflammation

  BACKGROUND: Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. [ncbi.nlm.nih.gov]

  Original Title : Chronic Pelvic Inflammation Diminished Ovarian Reserve as Indicated by Serum Anti Mülerrian Hormone. [medivizor.com]

  […] disease, Inflammation pelvic, Pelvic inflammation, Pelvic Infection, Fem pelv inflam dis NOS, Pelvic inflammatory disease (PID), Pelvic Inflammatory Disease [Disease/Finding], pelvic inflammation, pelvic inflammatory diseases, Disease;pelvic inflammatory [fpnotebook.com]

  Pelvic inflammatory disease (pid) is an acute or chronic inflammation in the pelvic cavity. [icd10data.com]

  […] of vagina and vulva N77* Vulvovaginal ulceration and inflammation in diseases classified elsewhere N77.0* Ulceration of vulva in infectious and parasitic diseases classified elsewhere Ulceration of vulva in: · herpesviral [herpes simplex] infection [apps.who.int]

• Asymptomatic

  Gonorrhoea tends to cause more of an acute infection 60% of chlamydia cases are asymptomatic 10% of cases occur after childbirth, particularly if forceps are used. [almostadoctor.co.uk]

  Asymptomatic disease should be treated. A 26, 27 The frequency and cost-effectiveness of screening for asymptomatic lower genital tract chlamydial infection are not clear. [aafp.org]

  Pid may be either symptomatic or asymptomatic. It may cause infertility and it may raise the risk of ectopic pregnancy. Pid is a disease associated with hiv infection. [icd10data.com]

  Pelvic inflammatory disease many not produce any symptoms or signs (referred to as being asymptomatic). In other cases it can cause fever, abdominal or pelvic pain, vaginal discharge, painful urination, or painful sexual intercourse. [medicinenet.com]

• Abdominal Pain

  RESULTS: Patients with irritable bowel syndrome suffered significantly more upper abdominal pain, colicky pain and exacerbation of pain by food or stress. They also experienced more disturbance of bowel habit, distension and nausea. [ncbi.nlm.nih.gov]

  […] eyes Dry mouth Anorexia Infertility Abdominal pain Anxiety Spontaneous sweating or night sweats with fever Dry eyes Hypochondriac pain Anorexia Somnolence Insomnia Aching shoulders Five sole Heat Earache Premenstrual tension Hot flashes Fatigue Lassitude [americandragon.com]

  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]

  […] mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia) among sexually active patients who may be at risk for PID. [pedsinreview.aappublications.org]

  Patients usually present during their menstruation, another clue towards PID as the cause of abdominal pain. Pelvic pain is exacerbated by intercourse, motion or exercise. [lecturio.com]

• Vomiting

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

  If nausea and vomiting are present, this suggests peritonitis. [almostadoctor.co.uk]

  Symptoms of PID Symptoms of pelvic inflammatory disease may include: Pain in your lower abdomen and pelvis Heavy vaginal discharge with an unpleasant odor Irregular menstrual bleeding Pain during intercourse Low back pain Fever, fatigue, diarrhea, or vomiting [utswmedicine.org]

  […] extremely careful if you notice any of the following: Symptoms of PID Cramping, pain, or tenderness in the pelvic or lower abdominal (stomach) area Bleeding between periods Increased or different discharge from your vagina Pain when having sex Nausea and/or vomiting [iwannaknow.org]

  Get medical help right away if you have: Severe pain in your lower belly Signs of shock, like fainting Vomiting Fever higher than 101 F Some of these also can be signs of other serious medical conditions, like appendicitis or an ectopic pregnancy (a pregnancy [webmd.com]

• Nausea

  They also experienced more disturbance of bowel habit, distension and nausea. [ncbi.nlm.nih.gov]

  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]

  If nausea and vomiting are present, this suggests peritonitis. [almostadoctor.co.uk]

  Acute PID is accompanied by the following signs and symptoms: Severe pain and tenderness in lower abdomen Vaginal discharge Abnormal uterine bleeding or tenderness Fever Nausea and vomiting Chronic PID is accompanied by the following signs and symptoms [sutterhealth.org]

  […] must be extremely careful if you notice any of the following: Symptoms of PID Cramping, pain, or tenderness in the pelvic or lower abdominal (stomach) area Bleeding between periods Increased or different discharge from your vagina Pain when having sex Nausea [iwannaknow.org]

• Diarrhea

  Symptoms of PID Symptoms of pelvic inflammatory disease may include: Pain in your lower abdomen and pelvis Heavy vaginal discharge with an unpleasant odor Irregular menstrual bleeding Pain during intercourse Low back pain Fever, fatigue, diarrhea, or [utswmedicine.org]

  The patient’s pain began gradually and increased in severity over a few days.She had no fever, nausea, diarrhea, constipation or other changes in bowel or bladder habits. The pain was exacerbated on motion but did not improve with resting. [austinpublishinggroup.com]

  […] include dyspareunia (painful sexual intercourse); fever greater than 101°F; general malaise; anorexia; headache; nausea, possibly with vomiting; urinary problems such as dysuria, frequency, urgency, and burning; menstrual irregularity; and constipation or diarrhea [medical-dictionary.thefreedictionary.com]

• Low Back Pain

  Symptoms of PID Symptoms of pelvic inflammatory disease may include: Pain in your lower abdomen and pelvis Heavy vaginal discharge with an unpleasant odor Irregular menstrual bleeding Pain during intercourse Low back pain Fever, fatigue, diarrhea, or [utswmedicine.org]

  Symptoms can include: Pain and tenderness in the lower abdomen Heavy vaginal discharge with a strong unpleasant odour Irregular or heavy menstrual periods Pain during sexual intercourse Low back pain Flu-like symptoms such as fever, nausea and vomiting [irishhealth.com]

  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]

• Pelvic Pain

  BACKGROUND: Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. [ncbi.nlm.nih.gov]

  It can also cause chronic pelvic pain and ectopic pregnancy. [livescience.com]

  When they are present they may include : lower abdominal or pelvic pain abnormal vaginal discharge irregular menstrual bleeding fever pain during sexual intercourse painful or increased urination. [theconversation.com]

  Treatment of PID Related Pain After PID has been treated, pelvic pain can remain for some women. Pain may be caused by adhesions and scar tissue, which is not treated by the antibiotics. [verywell.com]

• 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. [saem.org]

  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 gonorrhea Rates of [pedemmorsels.com]

  […] or uterine tenderness or adnexal tenderness. [mshc.org.au]

  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]

  The major criteria include: 1) uterine tenderness, 2) cervical motion tenderness (CMT), and 3) adnexal tenderness. Minor criteria may increase the clinician’s suspicion and improve the specificity of exam findings for the diagnosis of PID. [clinicaladvisor.com]

• Dyspareunia

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

  […] 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 woman usually presents with symptoms of pelvic pain, heavy and painful menstrual periods, pain with intercourse (dyspareunia) and/or infertility that triggers an evaluation that reveals extensive pelvic scar tissue. [haveababy.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]

  Other causes of dyspareunia - eg, endometriosis. Investigations Pregnancy test (pregnant women with PID should be admitted; ectopic pregnancy may be confused with PID). [patient.info]

• Dysuria

  She denies dysuria, but has had some light vaginal discharge that started about 1 week ago. [pedsinreview.aappublications.org]

  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]

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

  Discharge from the vagina and dysuria also occur. Menstrual irregularity if any, is due to preceding endometritis in case of ascending infection or to the antecedent abortion or delivery. [physiotherapy-treatment.com]

  Other symptoms include vaginal discharge, dyspareunia, dysmenorrhea, dysfunctional uterine bleeding, postcoital bleeding, dysuria, low back pain, nausea and vomiting, and fever. [clinicaladvisor.com]

• Pelvic Pain in Women

  It also can cause severe pain and make it difficult to become pregnant. How common is pelvic inflammatory disease (PID)? Each year, more than 1 million women in the United States have an episode of PID. [my.clevelandclinic.org]

  If painkillers don't control your pain, you may be referred to a pain management team or a specialist pelvic pain clinic. [nhs.uk]

  This damage can lead to serious health problems such as infertility (unable to have children) or chronic pelvic pain. Some women may even experience ectopic pregnancies (pregnancies outside of the womb). [bphc.org]

Diagnostic Work-up for Pelvic Inflammatory Disease The threshold to diagnose PID should be low to avoid possible complications, yet several diagnostic workup studies have been evaluated to improve the certainty of the diagnosis. [lecturio.com]

• Chlamydia

  Prompt treatment of chlamydia and gonorrhoea infections is essential for the prevention of potential PID. In Australia, rates of chlamydia and gonorrhoea diagnoses are highest among 15- to 24-year-olds. [theconversation.com]

  You are more likely to get PID if: You have a sex partner with gonorrhea or chlamydia. You have sex with many different people. You have had an STI in the past. You have recently had PID. You have contracted gonorrhea or chlamydia and have an IUD. [medlineplus.gov]

  Occurs in 40% of women developing endocervicitis from untreated Neisseria gonorrhoeae or Chlamydia trachomatis. [lecturio.com]

  Two sexually transmitted infections (STIs) — gonorrhea and chlamydia —are the main cause of PID. Gonorrhea and chlamydia may cause vague symptoms or even no symptoms in a woman. [acog.org]

  PID is usually caused by 2 sexually transmitted infections : chlamydia or gonorrhea. [plannedparenthood.org]

• Chlamydia Trachomatis

  Neisseria gonorrhea, Chlamydia trachomatis, and a wide variety of aerobic and anerobic bacteria are most frequently isolated from women with PID. [ncbi.nlm.nih.gov]

  Occurs in 40% of women developing endocervicitis from untreated Neisseria gonorrhoeae or Chlamydia trachomatis. [lecturio.com]

  Chlamydia trachomatis infection of human fallopian tube organ cultures. [glowm.com]

  The role of spermatozoa in the pathogenesis of Chlamydia trachomatis salpingitis in a primate model. Sex Transm Dis. 1993 Jul-Aug. 20(4):214-9. [Medline]. Paavonen J. Chlamydia trachomatis infections of the female genital tract: state of the art. [emedicine.medscape.com]

  PID is most commonly caused by sexually transmitted diseases (STDs), such as chlamydia trachomatis and Neisseria gonorrhoeae. [sutterhealth.org]

A thermal dosage treatment lasting between 20 and 30 minutes (for each half of the cross-fire technique treatment) was administered. At the beginning of every treatment session, the patient rated her pain perception on a 10-point ratio scale. [ncbi.nlm.nih.gov]

In the early stages the emphasis of treatment is to eliminate the exogenous pathogenic evil. In the later stages the emphasis shifts to restoring or augmenting genuine Qi. [americandragon.com]

Mycoplasma genitalium can also cause PID and is less responsive to the recommended treatment for PID. [mshc.org.au]

Prognosis of pelvic inflammatory disease The prognosis of PID depends mostly on the awareness of adolescents to look for timely health care and to prevent future episodes of sexually-transmitted infections. [news-medical.net]

What Is the Prognosis? Antibiotic treatment successfully resolves most PID infections. [healthychildren.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]

BACKGROUND: Chronic pelvic inflammation disease (PID) is a difficult-to-treat gynecological disorder with complex etiologies. Acupuncture has been applied widely for treating chronic pelvic inflammation or chronic pelvic pain symptoms in China. [ncbi.nlm.nih.gov]

Etiology of Pelvic Inflammatory Disease Pelvic inflammatory disease is an infectious disorder. Chlamydia trachomatis and Neisseria gonorrhoeae are the two most commonly identified etiological organisms of PID. [lecturio.com]

The microbial etiology is linked to sexually transmitted microorganisms, including Chlamydia trachomatis, Neisseria gonorrheae, Mycoplasma genitalium, and bacterial vaginosis-associated microorganisms, predominantly anaerobes. [journals.lww.com]

Eschenbach DA, Buchanan T, Pollock HM et al. (1975) Polymicrobial etiology of acute pelvic inflammatory disease. N Engl J Med 293:166 Google Scholar 5. [link.springer.com]

Epidemiology and trends in the United States 1975 and 1981. JAMA 251:2529–2533 Google Scholar 13. Westrom L (1980) Incidence, prevalence and trends of acute pelvic inflammatory disease and its consequences in industrialized countries. [link.springer.com]

[…] inflammatory disease (PID) -- usually a spontaneous infection that occurs among sexually active, menstruating, nonpregnant women -- covers: pathophysiology; microbial etiology (gonorrhea, chlamydia, genital mycoplasmas, and aerobic and anerobic bacteria); epidemiology [ncbi.nlm.nih.gov]

Objectives After completing this article, readers should be able to: Describe the epidemiology and pathogenesis of pelvic inflammatory disease (PID). Recognize the clinical features of PID. [pedsinreview.aappublications.org]

Sexually transmitted diseases, pelvic inflammatory disease, and infertility: an epidemiologic update. Epidemiol Rev. 1990;12:199-220. Cates W Jr, Wasserheit JN. Genital chlamydial infections: epidemiology and reproductive sequelae. [std.uw.edu]

Epidemiology of Pelvic Inflammatory Disease Pelvic inflammatory disease is a common condition in the United States and approximately 2.5 million women develop PID per year. Up to 150,000 patients are hospitalized per year because of PID. [lecturio.com]

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]

Pathophysiology of Pelvic Inflammatory Disease PID occurs in two subsequent steps or stages. At first, the patient develops a sexually transmitted infection that is usually chlamydial and asymptomatic. [lecturio.com]

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]

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 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]

Resources: Division of STD Prevention (DSTDP) Centers for Disease Control and Prevention - www.cdc.gov/std CDC National Prevention Information Network (NPIN) 1-800-458-5231 - www.cdcnpin.org American Sexual Health Association (ASHA) 1-800-783-9877 - www.ashastd.org [healthcenter.indiana.edu]

The cervix produces mucus that normally prevents bacteria from spreading to the upper reproductive tract. [medbroadcast.com]

How can I prevent PID? Getting tested for STDs is one of the best ways to prevent PID, because PID is usually caused by chlamydia or gonorrhea. [plannedparenthood.org]

Centers for Disease Control and Prevention. (2015). PID. Centers for Disease Control and Prevention. (2015). 2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID). [womenshealth.gov]

Prevention of PID Seek medical advice for abnormal vaginal discharge, abnormal odor, fever, and bleeding between periods. Early treatment can prevent the development of PID. [healthcommunities.com]