Find information on thousands of medical conditions and prescription drugs.

Pelvic inflammatory disease

Pelvic inflammatory disease (or disorder) (PID) is a generic term for infection of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to tissue necrosis with/or without abscess formation. Pus can be released into the peritoneum. 2/3 of patients with laparoscopic evidence of previous PID were not aware they had had PID (Cecil's 5th ed). PID is often associated with, because it is a common result of infection with, sexually transmitted diseases. PID is a vague term and can also refer to viral, or fungal, or parasitic, but usually with bacterial infections. more...

Home
Diseases
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Arthritis
Arthritis
Bubonic plague
Hypokalemia
Pachydermoperiostosis
Pachygyria
Pacman syndrome
Paget's disease of bone
Paget's disease of the...
Palmoplantar Keratoderma
Pancreas divisum
Pancreatic cancer
Panhypopituitarism
Panic disorder
Panniculitis
Panophobia
Panthophobia
Papilledema
Paraganglioma
Paramyotonia congenita
Paraphilia
Paraplegia
Parapsoriasis
Parasitophobia
Parkinson's disease
Parkinson's disease
Parkinsonism
Paroxysmal nocturnal...
Patau syndrome
Patent ductus arteriosus
Pathophobia
Patterson...
Pediculosis
Pelizaeus-Merzbacher disease
Pelvic inflammatory disease
Pelvic lipomatosis
Pemphigus
Pemphigus
Pemphigus
Pendred syndrome
Periarteritis nodosa
Perinatal infections
Periodontal disease
Peripartum cardiomyopathy
Peripheral neuropathy
Peritonitis
Periventricular leukomalacia
Pernicious anemia
Perniosis
Persistent sexual arousal...
Pertussis
Pes planus
Peutz-Jeghers syndrome
Peyronie disease
Pfeiffer syndrome
Pharmacophobia
Phenylketonuria
Pheochromocytoma
Photosensitive epilepsy
Pica (disorder)
Pickardt syndrome
Pili multigemini
Pilonidal cyst
Pinta
PIRA
Pityriasis lichenoides...
Pityriasis lichenoides et...
Pityriasis rubra pilaris
Placental abruption
Pleural effusion
Pleurisy
Pleuritis
Plummer-Vinson syndrome
Pneumoconiosis
Pneumocystis jiroveci...
Pneumocystosis
Pneumonia, eosinophilic
Pneumothorax
POEMS syndrome
Poland syndrome
Poliomyelitis
Polyarteritis nodosa
Polyarthritis
Polychondritis
Polycystic kidney disease
Polycystic ovarian syndrome
Polycythemia vera
Polydactyly
Polymyalgia rheumatica
Polymyositis
Polyostotic fibrous...
Pompe's disease
Popliteal pterygium syndrome
Porencephaly
Porphyria
Porphyria cutanea tarda
Portal hypertension
Portal vein thrombosis
Post Polio syndrome
Post-traumatic stress...
Postural hypotension
Potophobia
Poxviridae disease
Prader-Willi syndrome
Precocious puberty
Preeclampsia
Premature aging
Premenstrual dysphoric...
Presbycusis
Primary biliary cirrhosis
Primary ciliary dyskinesia
Primary hyperparathyroidism
Primary lateral sclerosis
Primary progressive aphasia
Primary pulmonary...
Primary sclerosing...
Prinzmetal's variant angina
Proconvertin deficiency,...
Proctitis
Progeria
Progressive external...
Progressive multifocal...
Progressive supranuclear...
Prostatitis
Protein S deficiency
Protein-energy malnutrition
Proteus syndrome
Prune belly syndrome
Pseudocholinesterase...
Pseudogout
Pseudohermaphroditism
Pseudohypoparathyroidism
Pseudomyxoma peritonei
Pseudotumor cerebri
Pseudovaginal...
Pseudoxanthoma elasticum
Psittacosis
Psoriasis
Psychogenic polydipsia
Psychophysiologic Disorders
Pterygium
Ptosis
Pubic lice
Puerperal fever
Pulmonary alveolar...
Pulmonary hypertension
Pulmonary sequestration
Pulmonary valve stenosis
Pulmonic stenosis
Pure red cell aplasia
Purpura
Purpura, Schoenlein-Henoch
Purpura, thrombotic...
Pyelonephritis
Pyoderma gangrenosum
Pyomyositis
Pyrexiophobia
Pyrophobia
Pyropoikilocytosis
Pyrosis
Pyruvate kinase deficiency
Uveitis
Q
R
S
T
U
V
W
X
Y
Z
Medicines

PID should be classified by affected organs, the stage of the infection, and the organism(s) causing it. Although very commonly a sexually transmitted infection is the likely cause, other routes are possible for some agents including lymphatic, often postpartum, postabortal (either miscarriage or abortion) or IUD related, and hematogenous spread.

Epidemiology

In the United States, more than one million women are affected by PID each year, and the rate is highest with teenagers. Approximately 50,000 women become infertile in the US each year from PID . N. gonorrhoea is isolated in only 40-60% of women with acute salpingitis (current obgyn 9th ed 2003). C. trachomatis was estimated by current obgyn 9th ed to be the cause in about 60% of cases of , which may lead to PID. It is unsure how much is due to a single organism and how much is due to multiple organisms; many other pathogens that are in normal vaginal flora become involved in PID. 10% of women in one study had asymptomatic Chlamydia trachomatis infection and 65% had asymptomatic infection with Neisseria gonorrhoeae (current obgyn 9th ed.) It was noted in one study that 10-40% of untreated women with N. gonorrhoea develop PID and 20-40% of women infected with C. trachomitis developed PID.(Cecil's essentials of medicine 5th ed.). "PID is the leading cause of infertility. A single episode of PID results in infertility in 13% of women." (Cecil's 5th ed.) This rate of infertility increases with each infection.

Diagnosis

There may be no actual symptoms of PID. If there are symptoms, fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, or irregular menstrual bleeding may be noted. It is important to note that PID can occur and cause serious harm without causing any noticeable symptoms. Laparoscopic idenitification is helpful in diagnosing tubal disease, 65-90% positive predictive value in patients with presumed PID (current obgyn 9th ed 2003). Regular STD testing is important for prevention. Treatment is usually started empirically because of the terrible complications. Definitive criteria include: histopathologic evidence of endometritis, thickened filled fallopian tubes, or laparoscopic findings. Gram-stain/smear becomes important in identification of rare and possibly more serious organisms (cecil's 5th ed.).

Prognosis

Although the PID infection itself may be cured, effects of the infection may be permanent. This makes early identification by someone who can prescribe appropriate curative treatment so important in the prevention of damage to the reproductive system. Since early gonococcal infection may be asymptomatic, regular screening of individuals at risk for common agents (history of multiple partners, history of any unprotected sex, or people with symptoms) or because of certain procedures (post pelvic operation, postpartum, miscarriage or abortion). Prevention is also very important in maintaining viable reproduction capabilities. If the initial infection is mostly in the lower tract, after treatment the person may have little difficulties. If the infection is in the fallopian tubes or ovaries, more serious complications are more likely to occur.

Read more at Wikipedia.org


[List your site here Free!]


Which blood tests are most helpful in evaluating pelvic inflammatory disease?
From Journal of Family Practice, 4/1/04 by Mary N. Hall

* EVIDENCE-BASED ANSWER

No individual or combination of blood tests can reliably diagnose pelvic inflammatory disease (PID) (strength of recommendation [SOR]: A, meta-analysis). The combination of white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and vaginal white blood cells can reliably exclude PID if results for all 4 tests are normal (sensitivity=100%) (SOR: B, cohort study, reference standard not uniformly applied).

The combination of CRP and ESR is helpful in excluding PID (sensitivity=91%) and may be especially useful in distinguishing mild from complicated cases (SOR: B, small cohort study). Individual tests do not appear to significantly improve diagnostic accuracy, although the CRP and ESR are somewhat useful to rule out PID (SOR: B, small cohort study).

* EVIDENCE SUMMARY

Because of the significant inflammatory sequelae of PID, it is the standard of care to treat women with suggestive signs and symptoms. Clinical diagnosis has a positive predictive value of 65% to 90% compared with laparoscopy. (1) While no single test is both sensitive and specific, a combination of biochemical tests for inflammation may improve the ability to rule out PID.

A prospective cohort study of 120 women presenting to an ambulatory center with symptoms of PID evaluated the tests commonly used to support the clinical diagnosis of PID. (2) The objective criteria used for diagnosis included histologic evidence of acute endometritis via endometrial biopsy, purulent exudates in the pelvis on laparoscopy, or microbiologic evidence of Neisseris gonorrhea or Chlamydia trachomatis from the upper genital tract. The Table shows the sensitivities, specificities, and predictive values for an elevated white blood cells (>10,000/mm), ESR (>15 mm/hr), CRP (>5 mg/dL), and increased vaginal white blood cells (>3 white blood cells/high-power field) for detection of PID. If all 4 test results are negative, PID is reliably ruled out with a sensitivity of 100%. These results may be an overestimate, as the gold standard was not uniformly applied.

The role of CRP and ESR in the diagnosis of acute PID was studied in 41 women with clinically suspected acute PID who presented to a university department of obstetrics and gynecology? Women underwent laparoscopy, endometrial sampling, and cultures of the upper genital tract to confirm the diagnosis. When considered together, a positive value in either the ESR (cutoff level of 15 mm/hr) or CRP (cutoff >20 mg/dL) had a sensitivity of 91% and a specificity of 50%.

Another report looked at the ability of ESR and CRP to differentiate between mild, moderate, and severe PID in 72 women undergoing laparoscopy at a university department of gynecology. (4) The cutoff levels were ESR >40 mm/hr and CRP >60 mg/dL. If either test was abnormal, the sensitivity and the negative predictive value for severe disease were 97% and 96%, respectively (Table). All patients with tuboovarian abscess or perihepatitis and 6 of 7 patients who had anaerobic bacteria isolated from the fallopian tubes tested positive with these cutoff levels.

A meta-analysis from 1991 found 12 studies, not including any of the above studies, and assessed the laboratory criteria for the diagnosis of PID. No single or combination diagnostic indicator was found to reliably predict PID. However, the CRP and the ESR were useful in ruling out PID, with good sensitivities for CRP in 4 of 4 studies analyzed (74%-93%) and for the ESR in 4 of 6 studies (64%-81%). Ten of 12 studies used laparoscopy as the gold standard. (5)

* RECOMMENDATIONS FROM OTHERS

The Centers for Disease Control and Prevention makes no specific recommendation for the use of specific blood tests in the diagnosis of PID. (1) The Association for Genitourinary Medicine states that an elevated ESR or CRP supports the diagnosis of PID. (6)

* CLINICAL COMMENTARY

When diagnosing PID, a clinician must have a high index of suspicion

PID is a difficult diagnosis to make, without clear-cut diagnostic guideposts. The sequelae of PID can be so serious that clinicians must not miss this diagnosis. If results of all 4 tests described above are negative, this can reliably rule out the diagnosis.

Unfortunately, no set of tests can reliably confirm the diagnosis in all cases. The traditional triad of lower abdominal pain, cervical motion tenderness, and adnexal pain are still taught as the classic findings for diagnosing PID. The clinician must also have a high index of suspicion, particularly with teen-agers with abdominal pain, and when the pain is indolent and lingering.

Nonetheless, a recent study concludes there is insufficient evidence to support existing clinical diagnostic criteria and recommends that the clinical criteria for PID be redefined. In a group of patients with laparoscopically confirmed PID, no variable (abnormal vaginal discharge, fever >38[degrees]C, vomiting, menstrual irregularity, ongoing bleeding, symptoms of urethritis, rectal temperature >38[degrees]C, marked tenderness of pelvic organs on bimanual examination, adnexal mass, and ESR >15 mm) reliably predicted the disease, and found, rather, that most had low specificity and sensitivity. The chance of having PID based on the presence of lower abdominal pain was 79%. Three variables predicted 65% of the cases of PID: elevated ESR, fever, and adnexal tenderness. When evaluating patients for admission, some authors add "the desire to bear children" to the standard admission criteria, which include severity of sickness, pregnancy, possible need for surgical intervention, lack of response to oral medications, or immunosuppression.

Ellen Beck, MD, University of California-San Diego

REFERENCES

(1.) Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2002; 51 (RR-6):48-52.

(2.) Peipert JF, Boardman L, Hogan JW, Sung J, Mayer KH. Laboratory evaluation of acute upper genital tract infection. Obstet Gynecol 1996; 87:730-736.

(3.) Lehtinen M, Laine S, Heinonen PK, et al. Serum C-reactive protein determination in acute pelvic inflammatory disease. Am J Obstet Gynecol 1986; 154:158-159.

(4.) Miettinen AK, Heinonen PK, Laippala P, Paavonen J. Test performance of erythrocyte sedimentation rate and C-reactive protein in assessing the severity of acute pelvic inflammatory disease. Am J Obstet Gynecol 1993; 169:1143-1149.

(5.) Kahn JG, Walker CK, Washington AE, Landers DV, Sweet RL. Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model. JAMA 1991; 266:2594-2604.

(6.) 2002 Guidelines for the management of pelvic infection and perihepatitis. London: Association for Genitourinary Medicine (AGUM); Medical Society for the Study of Venereal Disease (MSSVD); 2002. Available at: www.agum.org.uk/ceg2002/pid0601.htm. Accessed on March 5, 2004.

Mary N. Hall, MD, Laura Leach, MLIS, Carolinas Healthcare System, Charlotte, NC

COPYRIGHT 2004 Dowden Health Media, Inc.
COPYRIGHT 2004 Gale Group

Return to Pelvic inflammatory disease
Home Contact Resources Exchange Links ebay