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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

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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, unilateral or 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.

Examination findings vary but may include fever, lower abdominal tenderness, tenderness on lateral motion of the cervix, unilateral or bilateral adnexal tenderness, and adnexal fullness. Leukocytosis, an elevated erythrocyte sedimentation rate, elevated C-reactive protein concentration, and/or an adnexal mass demonstrated by abdominal or transvaginal ultrasonography may be laboratory or imaging findings useful to support the diagnosis.

No single symptom, sign, or laboratory finding is sensitive and specific for the diagnosis of acute PID. Adnexal tenderness in a patient who has been sexually active has been described as the most sensitive finding for PID. Many episodes of PID go unrecognized by patients and/or health care professionals, because patients may be relatively asymptomatic ("silent PID") and do not seek care or because symptoms are mild and nonspecific. 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 495).

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This topic has been referenced by these articles:

• Buchanan;, I. D., Blake, D. R., Duggan, A., Quinn, T., Zenilman, J., Joffe, A. (2000). Evaluation of Vaginal Infections in Adolescent Women: Can It Be Done Without a Speculum?. Pediatrics 105: 156-157 [Full Version]  
• Greydanus, D. E., Patel, D. R., Rimsza, M. E. (2001). Contraception in the Adolescent: An Update. Pediatrics 107: 562-573 [Abstract] [Full Version]  

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