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Pelvic Inflammatory Disease: Diagnosis And Treatment In The Emergency Department

December 2016

Abstract

Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and evolving resistance patterns among pelvic inflammatory disease pathogens are reviewed.

Key words: pelvic inflammatory disease, cervical motion tenderness, adnexal tenderness, uterine tenderness, ectopic pregnancy, pelvic pain, dyspareunia, dysuria, postcoital bleeding, endometritis, salpingitis, oophoritis, pyosalpinx, peritonitis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, sexually transmitted infection, STI, Fitz-Hugh-Curtis, tubo-ovarian abscess, TOA, intrauterine device, IUD, bacterial vaginosis, trichomoniasis, gonorrhea, chlamydia, nucleic acid amplification test, NAAT, cogwheel sign, metronidazole

Points

  • Pelvic inflammatory disease (PID) can present with nonspecific symptoms such as vaginal discharge, postcoital bleeding, dyspareunia, and dysuria.
  • PID increases risk of infertility, pelvic scarring, chronic pain, and ectopic pregnancy; however, early treatment may prevent these conditions.

Pearl

  • PID can occur in patients who are not sexually active.
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