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]

• 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]

  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]

  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]

  Red eyes Dry mouth and throat Palpitations Lower abdominal pain Difficult urination Painful urination Increased menstrual flow Uterine bleeding Early menstruation Aching in limbs Dizziness Mental instability Red face Thirst Turbid urine Alternating chills [americandragon.com]

• Severe Pain

  Acute PID comes on suddenly and tends to be more severe, whereas chronic PID is a low-grade infection that may cause only mild pain and sometimes backache. Signs and Symptoms People who have PID may not have any symptoms. [sutterhealth.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]

  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]

  Usually lower region Can be bilateral or unilateral If pain is severe, may be associated with nausea and vomiting. [almostadoctor.co.uk]

  […] periods painful periods unusual vaginal discharge, especially if it's yellow or green A few women become very ill with: severe lower abdominal pain a high temperature (fever) nausea and vomiting When to seek medical advice It's important to visit your [nhs.uk]

• Surgical Procedure

  It is most commonly caused by sexually transmitted diseases, including chlamydia and gonorrhea that have ascended into the uterus, fallopian tubes, or ovaries as a result of intercourse or childbirth, or of surgical procedures, including insertion of [icd10data.com]

  A sample of vaginal discharge may also be taken for analysis and in some cases, a laparoscopy may be necessary to confirm the diagnosis — a laparoscopy is a minor surgical procedure carried out under anaesthesia during which a small incision is made in [irishhealth.com]

  Some surgical procedures, such as abortion, curette or insertion of an intrauterine device (IUD), can lead to PID. The infection usually occurs in three stages – the cervix is infected first, followed by the endometrium and then the fallopian tubes. [betterhealth.vic.gov.au]

  A laparoscopy is a surgical procedure in which a lit fiberoptic telescope is place through a small incision in the abdomen–this requires anesthesia and is not without risks. [cmdrc.com]

  PID rarely occurs after having certain surgical procedures, such as an abortion, or after treatment for an abnormal Pap test. What are the symptoms of PID? A woman with PID may not always have symptoms. [youngwomenshealth.org]

• Sighing

  Support Yang Eliminate Stasis Stop pain Herb Formulas Points Clinical Manifestations Distending pain in the lower abdomen, with guarding May be distending pain in the chest and breasts Epigastric distention Anorexia Restlessness Irascibility Frequent sighing [americandragon.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]

• Abdominal Tenderness

  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]

  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]

  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]

  Physical exam findings in PID often include the following: a temperature greater than 101 F (38.3 C); abnormal vaginal discharge ; lower abdominal tenderness when exterior pressure is applied; tenderness when the cervix is moved (during a bimanual or [emedicinehealth.com]

  tenderness, and diminution in uterine, adnexal, and cervical motion tenderness. [std.uw.edu]

• 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]

  Back to top of page [irishhealth.com]

  For women who do have symptoms, the most common ones are: Lower stomach and back pain Fever Unusual discharge from the vagina which may have a bad odor Pain and/or burning when she pees or during sex Bleeding even when it’s not her period Very rarely, [bphc.org]

  Symptoms of PID can include: Lower abdominal pain and/or lower back pain Longer and/or heavier menstrual periods Cramps or spotting throughout the month A different kind of vaginal discharge than usual (change in smell, color, or amount) Fever Vomiting [youngwomenshealth.org]

  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]

• 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]

• 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]

• Candida

  Medicine to prevent Candida infection ( thrush ) may be given to women who have a history of thrush while using antibiotics. [myvmc.com]

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]