View source for Pelvic inflammatory disease

==Background==
*Commonly begins as cervical infection (cervicitis) with gonorrhea or chlamydia

==Diagnosis==
#Pelvic pain (90%)
#Constitutional sx-Vaginal discharge (75%)
#Abnl pelvic exam (60%)
#Vaginal bleeding (40%) 

===CDC Treatment Criteria===
#Cervical motion tenderness (CMT) OR
#Uterine tenderness OR
#Adnexal tenderness
#Additional criteria that make the dx more likely:
##Fever
##WBC >10k
##Mucopurulent cervical or vaginal discharge
##WBCs on wet mount
##Proven infection w/ GC or chlamydia

^CDC Criteria are Sn, but not Sp (i.e. many intra-abominal processes have CMT) 

==Work-Up==
#Upreg (negative)
#Pelvic exam (send GC/Chlamy, wet mount)
#Pelvic US if toxic (r/o TOA)
#R/O other intra-abd pathology (consider CT, UA, labs) 

== Treatment ==
*Tx all partners that had sex w/ pt during previous 60d prior to onset of symptoms
=== Outpatient ===
#CTX 250mg IM x1 + doxycycline 100mg PO BID x14d +/- metronidazole 500mg PO BID x14d 
##Metronidazole based upon assessment of risk for anaerobes; consider in:
###Pelvic abscess 
###Proven or suspected infection w/ trichomonas or bacterial vaginosis 
###History of gynecological instrumentation in the preceding 2-3wks

=== Inpatient ===
#(Cefotetan 2gm IV q12h OR cefoxitin 2mg IV q6h) + doxycycline 100mg IV/PO q12h OR
#Clindamycin 900mg IV q8h + genamicin 2mg/kg QD OR
#Ampicillin/sulbactam 3gm IV q6hr + doxycycline 100mg IV/PO q12hr

==Disposition==
Admit for:
# TOA, Fitz-Hugh-Curtis
# Sepsis/peritonitis
# Unable to tol POs
# Failed outpt Rx

==Complications==
#TOA/sepsis
#Infertility
#[[Ectopic Pregnancy]]
#Chronic pelvic pain

==See Also==
[[Sexually Transmitted Diseases (STD)]]
[[Ectopic Pregnancy]]
[[Pelvic Pain]]

== Source ==
CDC 2010, KajiQuestions 

[[Category:ID]] [[Category:OB/GYN]]