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Pelvic inflammatory disease - Management
How should I diagnose pelvic inflammatory disease?

  • A diagnosis of pelvic inflammatory disease (PID) should be made on clinical grounds.
    • Negative swab results do not rule out a diagnosis of PID.
    • Do not delay making a diagnosis and initiating treatment whilst waiting for the results of laboratory tests.
  • Ectopic pregnancy should be ruled out.
  • Suspect PID if any of the following symptoms are present:
    • Pelvic or lower abdominal pain (usually bilateral).
    • Deep dyspareunia particularly of recent onset.
    • Abnormal vaginal bleeding (intermenstrual, postcoital, or 'breakthrough') which may be secondary to associated cervicitis and endometritis.
    • Abnormal vaginal or cervical discharge as a result of associated cervicitis, endometritis, or bacterial vaginosis. This is often very slight and may be transient, especially with chlamydial infection.
    • Right upper quadrant pain due to peri-hepatitis (Fitz–Hugh–Curtis syndrome).
      • Peri-hepatitis occurs in 10–20% of women with PID.
      • It is characterized by the development of adhesions between the liver and the peritoneum, causing right upper quadrant pain.
  • On examination look for:
    • Lower abdominal tenderness — usually bilateral.
    • Adnexal tenderness (with or without a palpable mass), cervical motion tenderness, uterine tenderness (on bimanual vaginal examination).
    • Abnormal cervical or vaginal mucopurulent discharge (on speculum examination).
    • A fever of greater than 38°C, although the temperature is often normal.
  • Take endocervical swabs for gonorrhoea and chlamydia and a high vaginal swab. Consider taking blood for a white cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein.

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