pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infectious and inflammatory disorder of the upper female reproductive tract, including the uterus, fallopian tubes, and adjacent pelvic structures. It is a common and serious disorder, initiated by infection, that ascends from the vagina and cervix. PID may produce tubo-ovarian abscess and extend to produce pelvic peritonitis and Fitz-Hugh-Curtis syndrome

The first stage involves acquisition of a vaginal or cervical infection. The original sexually transmitted infection (STI) may be asymptomatic. An estimated 10-20% of untreated chlamydial or gonorrheal infections progress to PID. In PID, the second stage of upper female genital tract infection occurs by direct ascent of micro-organisms from the vagina and cervix.

Abd pain: dull, aching or crampy, bilateral, and constant, dyspareunia, vaginal discharge/bleeding, elevated temp

lower abdominal tenderness, cervical motion tenderness, and uterine or adnexal tenderness.Mucopurulent cervicitis

Temperature higher than 38.3°C (101°F)Abnormal cervical or vaginal mucopurulent discharge

Presence of white blood cells (WBCs) on saline microscopy of vaginal secretions

Elevated erythrocyte sedimentation rateElevated C-reactive protein level

Laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis

Administer cefoxitin 2 g IV q6h or cefotetan 2 g IV q12h plus doxycycline 100 mg PO/IV q12h

outpatient treatmentRegimen A: Administer ceftriaxone 250 mg IM once as a single dose plus doxycycline 100 mg PO bid for 14 days, with or without metronidazole 500 mg PO bid for 14 days.