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Section 3. Summaries of Infectious Diseases
Pelvic Inflammatory Disease 1
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders of the female upper genital tract, including any combination of endometritis, parametritis, salpingitis, oophoritis, tubo-ovarian abscess, and pelvic peritonitis. Pelvic inflammatory disease typically manifests as dull, continuous, bilateral lower abdominal or pelvic pain that may range from indolent to severe. Additional symptoms can include fever, vomiting, an abnormal vaginal discharge, and irregular vaginal bleeding (signaling endometritis). Some patients have sharp right upper abdominal quadrant pain as a result of perihepatitis. Symptoms often begin within a week after the onset of menses, depending on the etiologic agent.
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Examination findings variably include fever, lower abdominal tenderness, tenderness on lateral motion of the cervix, adnexal tenderness that is generally but not always bilateral, and adnexal fullness. Leukocytosis, an erythrocyte sedimentation rate more than 15 mm per hour, and an adnexal mass demonstrated by abdominal or transvaginal ultrasonography are typical findings.
No single symptom, sign, or laboratory finding is sensitive and specific for the diagnosis of acute PID. Many episodes of PID go unrecognized, some because patients are asymptomatic ("silent PID") and others because the symptoms are mild and nonspecific, so the diagnosis is not considered. Combinations of findings that improve sensitivity (ie, correctly detect women who have PID) do so only while decreasing specificity (ie, incorrectly including women who do not have PID). The diagnostic criteria currently recommended by the Centers for Disease Control and Prevention are presented in Table 3.40 (p 469).
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