Pelvic inflammatory disease (PID) is a dire condition of female reproductive organs caused majorly by bacterial infections transferred commonly through STDs or less often through the non-STD pathway. The disease causes significant distress and can have a substantial effect on reproductive function and quality of life. PID is diagnosed in about 5% of women across the U.S., which is a concerning prevalence (CDC, 2019). In light of these facts, the present essay will explore PID in terms of its clinical presentation, physical assessment, and clinical management to develop a better knowledge of it.
One of the most widespread symptoms is abdominal pain, which is more common in acute forms of PID. The pain can also be bilateral and is often felt in the lower part of the abdomen. Increased heart rate and signs of dehydration are found among patients suffering from PID. PID patients may feel pain and discomfort during and/or after sexual intercourse in their genitalia, which is known as dyspareunia (CDC, 2019).
In later stages, patients may also suffer from vomiting and bleeding from the uterus. Among other symptoms, there may be increased abnormal vaginal discharge, increased temperature, pain during urination, and pelvic tenderness (CDC, 2019). It is important to note that any standalone symptom is not directly indicative of PID and several may be observed for more accurate diagnosis. In addition, due to the damage, the disease does to the reproductive health of a woman, the treatment is recommended to be started immediately.
Physical assessment may start from oral temperature check with 38.3° C (101° F) being a sign of PID. For diagnosing the disease, in the pelvic examination, CDC advises to check if at least one criteria of the following are met:
- Cervical motion tenderness;
- Uterine tenderness;
- Adnexal tenderness (CDC, 2019).
Yet, it is also pertinent to consider if a patient is in the at-risk population, which is 18-45 sexually active females with more than one partners, or in a relationship with a man with more than one sexual partner. In addition to these factors, a health provider needs to check for cervical or vaginal mucopurulent discharge. Among the most sensitive criteria is adnexal tenderness. In cases when a physician cannot establish a diagnosis solely from physical examination and patient history, laboratory tests could improve the clarity such as endometrial biopsy, sonography, and microscopy of vaginal fluid. Still, the empiric treatment is still a recommended clinical practice.
Due to the fact that commonly PID is caused by multiple pathogens, broad-spectrum antimicrobial oral treatment is recommended. Due to this factor, there seems to be no optimal and universal solution for mild PID. Anti-anaerobic treatment could be considered in cases when the exact bacterial mix is not yet established. In certain severe cases, patients with PID may be hospitalized. The criteria for hospitalization are as follows:
- urgent surgical appendicitis removal;
- tubo-ovarian abscess;
- a severe case of vomiting fever;
- no response to oral antimicrobial treatment;
- the outpatient regiment is not an option for a patient (CDC, 2015).
Inpatient treatment should be considered should at least one of these criteria is met. Among the most widely oral medicines is doxycycline. It is administered twice a day in a 100mg dosage for 14 days combined with a single dose of ceftriaxone (250 mg) intramuscularly. Doxycycline is also used as a post-clinical follow-up treatment for 1-2 days after discharge with symptomatic improvement (CDC, 2015).
Among other oral and intramuscular treatments are Metronidazole 500 mg orally two times a day for 14 days + single dose Cefoxitin (2g) intramuscularly + a single dose of Probenecid, 1 g orally and concurrently. Parenteral regimens include Cefotetan + Doxycycline or Cefoxitin + Doxycycline or Clindamycin + Gentamicin. All of these drugs are administered intravenously with an exception of Gentamicin (intramuscularly) and Doxycycline, which may be associated with pain experienced in IV infusions (CDC, 2015).
Center for Disease Control and Prevention (CDC). (2015). Pelvic inflammatory disease (PID). Web.
Center for Disease Control and Prevention (CDC). (2019). Pelvic inflammatory disease – CDC fact sheet. Web.