Pelvic Inflammatory Disease: Diagnosis and Treatment in Urgent Care (Infectious Disease CME and Pharmacology CME)

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Delivery Method:	Online
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Publication Date: October 2023 (Volume 2, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, and 4 AOA Category 2-B CME credits. CME expires 10/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits and 1 Pharmacology CME credits, subject to your state and institutional requirements.

Authors

Peer Reviewers

Charting & Coding Author

Abstract

Pelvic inflammatory disease is associated with complications that include infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. When only nonspecific signs and symptoms are present at clinical evaluation, the diagnosis may be delayed. Even when properly diagnosed, pelvic inflammatory disease is often treated in a suboptimal manner. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Emerging issues, including new pathogens and evolving resistance patterns among long-established pathogens, are also reviewed.

Case Presentations

A 30-year-old woman presents with lower abdominal pain...

• The patient denies any other gastrointestinal or urinary complaints and has no complaints of flank pain; she has normal vital signs. You note mild left adnexal tenderness without cervical motion tenderness or adnexal masses. There is no abnormal vaginal discharge.
• Her urine pregnancy test is negative, urinalysis is positive for small leukocyte esterase but is nitrite-negative, and a wet mount is without clue cells, yeast, or Trichomonas vaginalis.
• The patient asks, “Why do you think I am having this pain?” and you wonder if there is something else you should do…

A 22-year-old woman returns for re-evaluation 1 week after starting treatment for pelvic inflammatory disease...

• The patient was given 500 mg ceftriaxone IM in the ED followed by doxycycline 100 mg orally twice daily and metronidazole 500 mg twice daily. She was sent for an outpatient pelvic ultrasound after the initial visit; it showed no evidence of PID complications. Aftercare instructions were to return to the ED or urgent care in 48 to 72 hours for a recheck because she does not have access to primary care. She did not return until a week after the initial visit because of a work conflict.
• She continues to complain of nonspecific left lower abdominal pain. She states that the pain may be a bit more intense, but it has not changed in quality, position, or associated features.
• On your physical examination, the patient has left lower quadrant abdominal tenderness without guarding or rebound. Bimanual examination reveals mild left adnexal tenderness without a palpable mass. She states that she has been fully compliant with the doxycycline and metronidazole. She has not had intercourse since her diagnosis. Her previous records show a reassuring pelvic ultrasound, urinalysis, urine culture, and a negative HIV test.
• You are surprised to find that her gonorrhea/chlamydia nucleic acid amplification test from a cervical specimen showed no evidence of infection. After being told about her negative gonorrhea and chlamydia tests, she asks if she can stop taking the antibiotics…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.