Centers for Disease Control and Prevention (CDC). However, there is no single symptom, physical finding, or laboratory test that is sensitive or specific enough to definitively diagnose PIDThe history should focus on high-risk behaviors and symptoms. Risk factors associated with pelvic inflammatory disease. et al. Gottlieb SL, Clinical symptoms should improve within 72 hours of treatment, and if not, further evaluation is advised. Shang A, PID during pregnancy increases the risk of preterm delivery and increases maternal morbidity.Women with IUDs have an increased risk of PID only within the first three weeks after insertion of the IUD. U.S. Preventive Services Task Force. Repeat testing for women with chlamydia or gonorrhea is suggested three to six months after treatment.Women with HIV infection may be less likely to test positive for gonorrhea or chlamydia, but are more likely to have an infection from PID is uncommon during pregnancy, although if it occurs, it is usually within the first 12 weeks before the mucous plug can act as an adequate barrier. Ness RB, Sexually transmitted diseases treatment guidelines, 2010 [published correction appears inAdapted from Workowski KA, Berman S; Centers for Disease Control and Prevention (CDC). et al. et al. Risk of sequelae after Gottlieb SL, Gynecologic infections. Because of the potential for significant consequences if treatment is delayed, physicians should treat on the basis of clinical judgment without waiting for confirmation from laboratory or imaging tests. O'Sullivan MJ, et al. Aghaizu A,
Clark RA. Kip KE, Clinical inquiries. Although PID in pregnancy is uncommon, it is associated with an increase in both maternal and fetal morbidity. Which tests are most useful for diagnosing PID? Van Damme L, Failure of cefoxitin and doxycycline to eradicate endometrial Ness RB, Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. If there are symptoms, then The anatomical structure of the internal organs and tissues of the female reproductive tract provides a pathway for pathogens to ascend from the vagina to the pelvic cavity thorough the Rarely cases of PID have developed in people who have stated they have never had sex.Other imaging methods, such as ultrasonography, computed tomography (CT), and magnetic imaging (MRI), can aid in diagnosis.Nucleic acid amplification tests (NAATs), direct fluorescein tests (DFA), and enzyme-linked immunosorbent assays (ELISA) are highly sensitive tests that can identify specific pathogens present. Lin JS, Ellen JM. Hutchison SL, Chung SE, Early treatment of an STI gives you the best chance of avoiding PID. Effectiveness of chlamydia screening: systematic review. Markowitz LE. Simms I, MARGARET GRADISON, MD, MHS-CL, Duke University Medical Center, Durham, North CarolinaPelvic inflammatory disease is a polymicrobial infection of the upper genital tract. Cottrell BH. A sensitive serum Pelvic and vaginal ultrasounds are helpful in the diagnosis of PID. Although they are not needed routinely, the tests that are most specific for diagnosing PID include endometrial biopsy with histopathologic evidence of endometritis (74 percent sensitive; 84 percent specific); transvaginal sonography (30 percent sensitive; 76 percent specific), particularly with Doppler flow assessment; magnetic resonance imaging techniques showing thickened, fluid-filled tubes; or laparoscopic abnormalities consistent with salpingitis or peritonitis (81 percent sensitive; 100 percent specific).According to consensus data, the treatment of PID must be empiric because a definitive diagnosis is rarely known or confirmed at the time of presentation.There is controversy over the need for treatment that is effective against anaerobic bacteria in women with PID. Diaz R,
Holt K. Berman SM, Hosenfeld CB, Asymptomatic disease should be treated.The frequency and cost-effectiveness of screening for asymptomatic lower genital tract chlamydial infection are not clear.No single clinical finding or laboratory test is sensitive or specific enough to definitively diagnose PID.Empiric antibiotic treatment should be initiated at the time of presentation in patients with symptoms suspicious for PID, even if the diagnosis has not been confirmed.Women with mild to moderate PID may receive outpatient oral medical treatment without increased risk of long-term sequelae.Unless there is proven sensitivity, fluoroquinolones should not be used in women with PID because of widespread resistance in Screening for lower genital tract chlamydial infection in younger and high-risk populations is recommended to reduce the incidence of PID. Risk factors for PID include age younger than 25 years; young age at first sexual encounter (younger than 15 years); use of nonbarrier contraception, especially IUD or oral contraceptives; new, multiple, or symptomatic sex partners; a history of PID or sexually transmitted infection; or recent IUD insertion.Typically, women will present with some degree of lower abdominal or pelvic pain, although it may be mild.
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