Pelvic Inflammatory Disease

Maria Trent

doi:10.1542/pir.34-4-163

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Maria Trent, MD, MPH*

^*Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.

Author Disclosure
Dr Trent has disclosed no financial relationships relevant to this article. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.

Abbreviations

CDC:: Centers for Disease Control and Prevention
CPP:: chronic pelvic pain
CT:: computed tomography
IM:: intramuscular
IUD:: intrauterine device
IV:: intravenous
KOH:: potassium hydroxide
NAAT:: nucleic acid amplification testing
PEACH:: Pelvic Inflammatory Evaluation and Clinical Health
PID:: pelvic inflammatory disease
STI:: sexually transmitted infection

Practice Gaps

The U. S. Centers for Disease Control and Prevention (CDC) provides evidence-based, expert-driven guidelines for effective management of pelvic inflammatory disease (PID); however, clinician adherence to the guidelines has been problematic.
PID practice guideline adherence is an international problem, as evidenced by a 2012 audit in the United Kingdom demonstrating that 55.5% of patients with PID did not receive care according to the British Association of Sexual Health and HIV treatment recommendations. Clinician behavior can be enhanced with the use of institutionally driven protocols, especially those that include onsite dispensing of a full course of medications.
Women seeking infertility services who report a history of unexplained and untreated abdominal pain are significantly more likely to have tubal infertility than women without such history; therefore caution should be used in dismissing mild symptoms (mild non-specific abdominal pain, vaginal discharge, bleeding or dyspareunia) among sexually active patients who may be at risk for PID.

Objectives

After completing this article, readers should be able to:

Describe the epidemiology and pathogenesis of pelvic inflammatory disease (PID).
Recognize the clinical features of PID.
Develop a management strategy for adolescent patients who have PID.
Carefully weigh the options for the disposition of patients who have PID.

Prologue

Justine is a 17-year-old girl who presents for evaluation of lower abdominal pain that has been increasing over the past few days. Earlier today she was eating and drinking, but has developed some nausea in the past couple of hours without vomiting. She has had soft, regular bowel movements that are free of blood and mucus. She denies dysuria, but has had some light vaginal discharge that started about 1 week ago. Justine continues to …