Pediatric emergency medicine trisk 2134 2134
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CLINICAL PEARLS AND PITFALLS
One in eight sexually active adolescent girls will develop PID.
PID can lead to chronic pelvic pain, ectopic pregnancy, and infertility.
Acute presentation of PID is variable and patients may be well
appearing despite serious consequences of untreated disease.
Current Evidence
PID is a polymicrobial inflammatory condition of the female upper genital tract
caused by an ascending sexually transmitted infection that variably involves the
endometrium, fallopian tubes, ovaries, adjacent structures, and pelvic peritoneum.
An estimated one in eight sexually active adolescent girls develops PID before
reaching 20 years of age. Young age, a large number of sexual partners, and
nonbarrier contraceptive methods are risk factors for infection with N.
gonorrhoeae and C. trachomatis, the microorganisms responsible for initiating
most cases of acute PID. Other risk factors include cigarette smoking, recent
douching, bacterial vaginosis, previous gynecologic surgery, and HIV infection.
Patients with PID are at risk of serious acute and chronic complications such as
tuboovarian abscesses, infertility, and chronic pelvic pain. It has been estimated
that 20% of women with PID will have chronic pelvic pain. Half of all ectopic
pregnancies are thought to be the result of tubal damage produced by PID.
Women with a history of PID have a 10-fold risk of infertility with repeated bouts
substantially increasing the likelihood of infertility.
Clinical Considerations
Clinical Recognition
Although the constellation of symptoms and signs associated with PID—
abdominal pain, irregular uterine bleeding, abnormal vaginal discharge, and lower
abdominal and pelvic tenderness—is well known, no single symptom or sign or a
combination of symptoms and signs is both sensitive and specific. Clinical
findings that improve the specificity of the diagnosis of PID (i.e., increase the
likelihood that the diagnosis is correct) do so only at the expense of sensitivity
(i.e., exclude patients who do in fact have PID). Criteria for the diagnosis of PID
suggested by the CDC are shown in Table 92.2 . Because the diagnosis of PID is
imprecise, and the potential for damage to the reproductive health of the patient is
great, providers should maintain a low threshold for the diagnosis of PID.
