Recommendations and Rationale for the Treatment of Pelvic Inflammatory Disease

Oluwatosin Jaiyeoba; Gweneth Lazenby; David E Soper


Expert Rev Anti Infect Ther. 2011;9(1):61-70. 

In This Article


Clinicians should maintain a low threshold for the diagnosis of PID. The diagnosis should be considered in sexually active women with or without lower abdominal pain and symptoms noted in Box 1. A physical examination should be performed to assess the abdomen for tenderness. Vaginal secretions examination should be performed to assess for the presence of BV. Microscopy of the vaginal secretions (wet mount) should be examined for the presence of leukocytes as well as clue cells and trichomonads. The cervical canal should be examined for the presence of yellow or green mucopus and friability, and testing for C. trachomatis and N. gonorrhoeae should be performed. A bimanual pelvic examination should be performed to assess for pelvic organ tenderness and for evidence of a pelvic mass, which might suggest a TOA.

Other ancillary tests that can be performed in diagnosing PID include a complete blood count, erythrocyte sedimentation rate or C-reactive protein test. These tests are recommended for patients with clinically severe PID. Imaging studies are most helpful when ruling out competing differential diagnoses such as the use of pelvic ultrasonography to rule out symptomatic ovarian cysts and computed tomography to rule out appendicitis. Pelvic ultrasonography has limited sensitivity for the diagnosis of PID, but the specific finding of thickened fluid-filled tubes by ultrasonography supports the diagnosis of upper genital tract inflammation. Pelvic ultrasonography should be performed in patients requiring hospitalization or those with a pelvic mass noted on bimanual pelvic examination to further characterize what could be a TOA.

Women with evidence of lower genital tract infection (N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis or BV) and cervicovaginal inflammation and no pelvic organ tenderness can be treated for an uncomplicated lower genital tract infection or cervicitis (Box 2).[10] For those with lower genital tract inflammation and pelvic organ tenderness, treatment for the syndromic diagnosis of PID is required. Most women with PID are clinically mild or moderate cases and can be treated as outpatients. Women with severe PID or those meeting the criteria noted in Box 3 should be considered for hospitalization and inpatient parenteral therapy.


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