Materiały źródłowe

• #1

  https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/diagnosis/

  There’s no single test for diagnosing pelvic inflammatory disease (PID). It’s diagnosed based on your symptoms and a gynaecological examination. […] A positive test for chlamydia, gonorrhoea or mycoplasma genitalium supports the diagnosis of PID. […] As PID can be difficult to diagnose, other tests may also be required to look for signs of infection or inflammation or rule out other possible causes of your symptoms. […] In some cases, a laparoscopy (keyhole surgery) may be used to diagnose PID.

• #2 Pelvic Inflammatory Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499959/

  Pelvic inflammatory disease (PID) is defined as an inflammation of the upper genital tract due to an infection in women. The diagnosis of PID is primarily clinical and should be suspected in female patients with lower abdominal or pelvic pain and genital tract tenderness. PID is treated with antibiotics to cover the primary pathogens, including Neisseria gonorrhoeae and Chlamydia trachomatis. The diagnosis of pelvic inflammatory disease is clinical. It is defined by lower genital tract inflammation such as cervical discharge, an increased number of white blood cells on wet prep, or cervical friability. Laboratory evaluation should include a pregnancy test to exclude the possibility of an ectopic pregnancy as an alternate etiology of pelvic pain. Therefore, early and prompt treatment should be started based on clinical suspicion. PID should be considered in any sexually active young woman with pelvic or low abdominal pain and evidence of genital tract tenderness on exam.

• #3 About Pelvic Inflammatory Disease (PID) | Pelvic Inflammatory Disease (PID) | CDC

  https://www.cdc.gov/pid/about/index.html

  There are no tests for PID. A diagnosis is usually based on a combination of your medical history, physical exam, and other test results. […] If diagnosed and treated early, the complications of PID can be prevented.

• #4 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Acute PID is difficult to diagnose because of the considerable variation in symptoms and signs associated with this condition. […] Delay in diagnosis and treatment probably contributes to inflammatory sequelae in the upper genital tract. […] A PID diagnosis usually is based on imprecise clinical findings. […] Data indicate that a clinical diagnosis of symptomatic PID has a positive predictive value for salpingitis of 65%90%, compared with laparoscopy. […] Regardless of positive predictive value, no single historical, physical, or laboratory finding is both sensitive and specific for the diagnosis of acute PID. […] For example, requiring two or more findings excludes more women who do not have PID and reduces the number of women with PID who are identified. […] Episodes of PID often go unrecognized.

• #5 A Practical Approach to the Diagnosis of Pelvic Inflammatory Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3148590/

  The diagnosis of acute pelvic inflammatory disease (PID) is usually based on clinical criteria and can be challenging for even the most astute clinicians. […] Currently, no single test or combination of diagnostic indicators have been found to reliably predict PID, and laparoscopy cannot be recommended as a first line tool for PID diagnosis. […] The clinical diagnosis of PID is imprecise. Most studies confirm the positive predictive value (PPV) of a clinical diagnosis of PID for salpingitis of 65% when confirmed by laparoscopy. No single historical, physical, or laboratory finding is reliably diagnostic for acute PID. […] The diagnosis of PID should be considered in all sexually active women with or without lower abdominal pain and symptoms noted in Table 1. […] The Centers for Disease Control and Prevention (CDC) recommend empiric treatment for PID in sexually active young women (25 years old or younger) and other women at risk of STI (multiple sex partners or history of STI) if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following is appreciated on bimanual pelvic examination: cervical motion tenderness, uterine tenderness, or adnexal tenderness.

• #6 Pelvic inflammatory disease – Wikipedia

  https://en.wikipedia.org/wiki/Pelvic_inflammatory_disease

  Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system, mainly the uterus, fallopian tubes, and ovaries, and inside of the pelvis. The diagnosis is typically based on the presenting signs and symptoms. It is recommended that the disease be considered in all women of childbearing age who have lower abdominal pain. A definitive diagnosis of PID is made by finding pus involving the fallopian tubes during surgery. Ultrasound may also be useful in diagnosis. Upon a pelvic examination, cervical motion, uterine, or adnexal tenderness will be experienced. Mucopurulent cervicitis and or urethritis may be observed. In severe cases more testing may be required such as laparoscopy, intra-abdominal bacteria sampling and culturing, or tissue biopsy. Laparoscopy can visualize „violin-string” adhesions, characteristic of Fitz-Hugh-Curtis perihepatitis and other abscesses that may be present. Other imaging methods, such as ultrasonography, computed tomography (CT), and magnetic imaging (MRI), can aid in diagnosis. Blood tests can also help identify the presence of infection: the erythrocyte sedimentation rate (ESR), the C-reactive protein (CRP) level, and chlamydial and gonococcal DNA probes. Definitive criteria include histopathologic evidence of endometritis, thickened filled fallopian tubes, or laparoscopic findings. Gram stain/smear becomes definitive in the identification of rare, atypical and possibly more serious organisms. Laparoscopic identification is helpful in diagnosing tubal disease; a 65 percent to 90 percent positive predictive value exists in patients with presumed PID. Upon gynecologic ultrasound, a potential finding is tubo-ovarian complex, which is edematous and dilated pelvic structures as evidenced by vague margins, but without abscess formation. No single test has adequate sensitivity and specificity to diagnose pelvic inflammatory disease. A large multisite U.S. study found that cervical motion tenderness as a minimum clinical criterion increases the sensitivity of the CDC diagnostic criteria from 83 percent to 95 percent. However, even the modified 2002 CDC criteria do not identify women with subclinical disease.

• #7 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Because of the difficulty of diagnosis and the potential for damage to the reproductive health of women, health care providers should maintain a low threshold for the clinical diagnosis of PID. […] The recommendations for diagnosing PID are intended to assist health care providers to recognize when PID should be suspected and when additional information should be obtained to increase diagnostic certainty. […] Presumptive treatment for PID should be initiated for sexually active young women and other women at risk for STIs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following three minimum clinical criteria are present on pelvic examination: cervical motion tenderness, uterine tenderness, or adnexal tenderness.

• #8 Pelvic Inflammatory Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0415/p791.html

  Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. […] The diagnosis of PID is based primarily on clinical evaluation. Because of the potential for significant consequences if treatment is delayed, physicians should treat on the basis of clinical judgment without waiting for confirmation from laboratory or imaging tests. Most importantly, physicians must consider PID in the differential diagnosis in women 15 to 44 years of age who present with lower abdominal or pelvic pain and cervical motion or pelvic tenderness, even if these symptoms are mild. However, there is no single symptom, physical finding, or laboratory test that is sensitive or specific enough to definitively diagnose PID; clinical diagnosis alone is 87 percent sensitive and 50 percent specific.

• #9 Pelvic Inflammatory Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0415/p791.html

  One or more of the following minimum criteria must be present on pelvic examination to diagnose PID: Cervical motion tenderness, Uterine tenderness, Adnexal tenderness. The following criteria can improve the specificity of the diagnosis: Oral temperature 101F ( 38.3C), Abnormal cervical or vaginal mucopurulent discharge, Presence of abundant numbers of white blood cells on saline microscopy of vaginal fluid, Elevated erythrocyte sedimentation rate, Elevated C-reactive protein level, Laboratory documentation of cervical infection with gonorrhea or chlamydia. […] Nucleic acid amplification tests (e.g., strand displacement amplification, ligase chain reaction, or polymerase chain reaction testing) for Chlamydia trachomatis and Neisseria gonorrhoeae are sensitive (90 to 98 percent and 88.9 to 95.2 percent, respectively), specific (98 to 100 percent and 99.1 to 100 percent, respectively), and cost-effective for documenting the presence of these organisms. These tests can be used for vaginal or endocervical specimens collected by the physician, vaginal specimens self-collected by the patient, or urine samples.

• #10 Core Concepts – Pelvic Inflammatory Disease – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/pelvic-inflammatory-disease/core-concept/all

  The following summarizes the main criteria recommended in the 2021 STI Treatment Guidelines for making a diagnosis of PID, including criteria for initiating presumptive treatment. […] Presumptive PID treatment should be initiated for sexually active young women and other women at risk for STIs who are experiencing pelvic or lower abdominal pain unexplained by another illness AND if they meet at least one of the following three clinical criteria on pelvic examination: Cervical motion tenderness, or Uterine tenderness, or Adnexal tenderness. […] In some women with suspected PID, more extensive evaluation, such as radiographic imaging, biopsy, or laparoscopy, is warranted. […] If a diagnostic pathogen has not been identified and the response to initial treatment is not certain, testing for M. genitalium should be performed, unless this has already been done.

• #11 Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0915/p357.html

  Most women with PID have evidence of lower genital tract infection, such as mucopurulent discharge or an increase in white blood cells on saline microscopy (i.e., wet prep with at least one white blood cell per epithelial cell). […] Presumptive diagnosis is sufficient to initiate empiric antibiotic treatment, even in mildly symptomatic patients. […] Adding more diagnostic findings increases the specificity of diagnosis, but this comes at the risk of decreasing sensitivity, thereby potentially missing cases of PID. […] Findings that help support the diagnosis of PID are listed in Table 2. […] Bimanual examination should be performed on all patients with suspected PID to assess for cervical motion, uterine, and/or adnexal tenderness; adnexal masses; or tubo-ovarian abscess. […] All patients suspected of having PID should have a serum or urine pregnancy test; if positive, ectopic pregnancy should be excluded.

• #12 The ABCs of PID Diagnosis – What You Need to Know – The ObG Project

  https://www.obgproject.com/2016/07/21/headline-abcs-pid-diagnosis-need-know/

  Pelvic inflammatory disease (PID) is an inflammatory disorder of the upper female genital tract that includes endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis. Symptoms may be obvious (high fever, severe lower abdominal pain, peritoneal signs), subtle (abnormal bleeding, vaginal discharge, dyspareunia) or absent. […] Assume PID in a patient with lower abdominal/pelvic pain if […] One or more of the following on pelvic exam: […] Cervical motion tenderness (CMT) […] Uterine tenderness […] Adnexal tenderness […] Additional criteria to support the diagnosis of PID […] Oral temperature >101°F (>38.3°C) […] Abnormal cervical mucopurulent discharge or cervical friability […] Abundant WBCs on saline microscopy of vaginal fluid […] Elevated erythrocyte sedimentation rate (ESR)

• #13 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  More specific criteria for diagnosing PID include endometrial biopsy with histopathologic evidence of endometritis; transvaginal sonography or magnetic resonance imaging techniques demonstrating thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies indicating pelvic infection. […] A diagnostic evaluation that includes some of these more extensive procedures might be warranted in certain cases. […] Requiring that all three minimum criteria be present before the initiation of empiric treatment can result in insufficient sensitivity for a PID diagnosis. […] One or more of the following additional criteria can be used to enhance the specificity of the minimum clinical criteria and support a PID diagnosis. […] The majority of women with PID have either mucopurulent cervical discharge or evidence of WBCs on a microscopic evaluation of a saline preparation of vaginal fluid. […] If the cervical discharge appears normal and no WBCs are observed on the wet prep of vaginal fluid, a PID diagnosis is unlikely, and alternative causes of pain should be considered.

• #14 Core Concepts – Pelvic Inflammatory Disease – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/pelvic-inflammatory-disease/core-concept/all

  Pelvic inflammatory disease (PID) is a clinical syndrome characterized by infection and inflammation of the upper female genital tract. […] The diagnosis of PID may be challenging as women with PID often experience subtle clinical manifestations, and precise diagnostic criteria are lacking. […] Effective parenteral and oral treatments are available for PID that provide short-term clinical benefit and reduce the risk of developing long-term complications. […] Given the importance of prompt diagnosis and treatment of PID, the initial diagnosis is often made based on clinical findings. […] Routine initial laboratory testing for women with possible PID should include saline microscopy of vaginal fluid, nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea, urinalysis (with culture if indicated), and pregnancy test.

• #15 Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0915/p357.html

  The nucleic acid amplification tests for gonorrhea and chlamydia are highly sensitive (90% to 98% and 88.9% to 95.2%, respectively), specific (98% to 100% and 99.1% to 100%, respectively), and cost-effective. […] Negative results do not exclude infections of the upper reproductive tract, but a positive result in combination with one of the minimum criteria supports the diagnosis of PID. […] In cases of diagnostic uncertainty or findings suggestive of tubo-ovarian abscess, physicians may consider a variety of imaging modalities. […] Diagnostic evaluation should not delay treatment.

• #16 Pelvic Inflammatory Disease (PID)

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/genital/pelvic-inflammatory-disease/

  All women presenting with symptoms and/or signs suggestive of PID should have a pregnancy test performed. Suspected cases of PID in a pregnant woman should generally be referred to the Emergency Department. […] All women presenting with symptoms and/or signs suggestive of PID should have testing for STIs including HIV, hepatitis B, syphilis, gonorrhoea, chlamydia, trichomonas and Mycoplasma genitalium where possible before commencing antibiotics. Antibiotic treatment should be initiated while awaiting the results. […] Where possible, all patients being treated for PID should also have a culture taken for gonorrhoea sensitivity testing at the time of treatment. An endocervical swab sent in charcoal without delay is the test of choice in general practice. […] Review patient within 72 hours if treating in the community. If little or no improvement, consider referral to hospital or review the diagnosis. […] Individuals diagnosed with PID should be advised to abstain from sexual intercourse until treatment completed and where indicated their partner has been treated.

• #17 Which blood tests are most helpful in evaluating pelvic inflammatory disease? | MDedge

  https://community.the-hospitalist.org/content/which-blood-tests-are-most-helpful-evaluating-pelvic-inflammatory-disease

  No individual or combination of blood tests can reliably diagnose pelvic inflammatory disease (PID) (strength of recommendation [SOR]: A, meta-analysis). The combination of white blood cell count, Creactive protein (CRP), erythrocyte sedimentation rate (ESR), and vaginal white blood cells can reliably exclude PID if results for all 4 tests are normal (sensitivity=100%) (SOR: B, cohort study, reference standard not uniformly applied). […] The combination of CRP and ESR is helpful in excluding PID (sensitivity=91%) and may be especially useful in distinguishing mild from complicated cases (SOR: B, small cohort study). Individual tests do not appear to significantly improve diagnostic accuracy, although the CRP and ESR are somewhat useful to rule out PID (SOR: B, small cohort study). […] Clinical diagnosis has a positive predictive value of 65% to 90% compared with laparoscopy.

• #18 Which blood tests are most helpful in evaluating pelvic inflammatory disease? | MDedge

  https://community.the-hospitalist.org/content/which-blood-tests-are-most-helpful-evaluating-pelvic-inflammatory-disease

  A meta-analysis from 1991 found 12 studies, not including any of the above studies, and assessed the laboratory criteria for the diagnosis of PID. No single or combination diagnostic indicator was found to reliably predict PID. However, the CRP and the ESR were useful in ruling out PID, with good sensitivities for CRP in 4 of 4 studies analyzed (74%93%) and for the ESR in 4 of 6 studies (64%81%). […] The Centers for Disease Control and Prevention makes no specific recommendation for the use of specific blood tests in the diagnosis of PID. The Association for Genitourinary Medicine states that an elevated ESR or CRP supports the diagnosis of PID. […] When diagnosing PID, a clinician must have a high index of suspicion. PID is a difficult diagnosis to make, without clear-cut diagnostic guideposts. The sequelae of PID can be so serious that clinicians must not miss this diagnosis. If results of all 4 tests described above are negative, this can reliably rule out the diagnosis.

• #19 Pelvic Inflammatory Disease Workup: Approach Considerations, Laboratory Studies, Transvaginal Ultrasonography

  https://emedicine.medscape.com/article/256448-workup

  A number of procedures can be performed to improve the diagnosis of pelvic inflammatory disease (PID) and its complications. These procedures are not necessary, nor are they indicated, in the management of every case of PID. However, because of the difficulty of definitive clinical diagnosis and the number of surgical and gynecologic emergencies that may have similar presentations, the clinician should be aware of these modalities. […] Laparoscopy is the criterion standard for the diagnosis of PID, but the diagnosis of PID in emergency departments and clinics is often based on clinical criteria, with or without additional laboratory and imaging evidence. No single test is highly specific and sensitive for PID, but laboratory tests, imaging studies, and procedures may be used to increase the specificity of the diagnosis.

• #20 Pelvic inflammatory disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pelvic-inflammatory-disease?lang=us

  Pelvic inflammatory disease (PID) is a broad term that encompasses a spectrum of infection and inflammation of the upper female genital tract, resulting in a range of abnormalities. […] Imaging features are often non-specific but are disproportionate to what may be apparent from symptoms. If imaged early (e.g. during the cervicitis stage), there may be no finding. If imaged very late, there may be an adnexal mass-like region with surrounding inflammatory change, and the fallopian tube and ovary may not be distinguished. […] Ultrasound is usually the first imaging requested in a case of lower abdominal pain. […] Early findings in PID include indistinct uterine margins, echogenic pelvic fat, and fallopian tube thickening. […] In the most severe cases, ultrasound may show adnexal masses with a heterogeneous echo-pattern.

• #21 Pelvic inflammatory diseases (PID) | STI Guidelines Australia

  https://sti.guidelines.org.au/syndromes/pelvic-inflammatory-diseases-pid/

  Speculum examination allows for visualisation of the cervix. The presence of cervical mucopurulent discharge supports the diagnosis of PID. […] Pelvic ultrasound is useful to detect alternative causes of pain, if the diagnosis is uncertain. In PID, the pelvic ultrasound may be normal or may show indicators of pelvic inflammation with thickened and dilated fallopian tubes +/- free fluid. Transvaginal ultrasound is preferred.

• #22 Pelvic inflammatory disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/pelvic-inflammatory-disease/

  Pelvic inflammatory disease (PID) is a bacterial infection. It affects the female reproductive system including the womb, fallopian tubes and ovaries. […] Most symptoms are mild, making it difficult to diagnose. […] If you think you might have PID, get checked for free by: booking an appointment at your local sexual health service or contacting your GP practice for an appointment. […] There is no single test for diagnosing PID. […] When your doctor examines you, theyll look for tenderness in your pelvic region and an abnormal vaginal discharge. […] However, a swab test cant be relied on to diagnose PID, as some women with PID have a negative swab result. […] You may have an ultrasound scan. Scans can identify severe PID but will not show up mild disease. Its possible to have a normal scan and still have PID.

• #23 Pelvic Inflammatory Disease (PID) Symptoms, Signs, Causes & Treatment

  https://www.emedicinehealth.com/pelvic_inflammatory_disease/article_em.htm

  A pelvic ultrasound, although not routinely done, can be an important tool in diagnosing complications such as tubo-ovarian abscesses, ovarian torsion, ovarian cysts, and ectopic pregnancy. […] A woman’s health specialist (a gynecologist) can use a laparoscope (a small tube with a camera attached) and make small surgical incisions in and around the navel to view the reproductive organs and evaluate whether inflammation is present. […] A health care practitioner will start antibiotic therapy for PID as soon as the diagnosis is made. Gonorrhea and chlamydia are suspected and treated in every person. […] Because samples of the bacteria from the upper genital tract are difficult to obtain and because many different organisms may be responsible for PID, especially if it is not the person’s first occurrence, the doctor will usually prescribe at least two antibiotics at the same time that are effective against a wide range of infectious bacteria.

• #24 Pelvic inflammatory disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pelvic-inflammatory-disease?lang=us

  CT findings include fallopian tube thickening of 5 mm with enhancing wall: has high specificity of 95%, indistinct uterine border, thickening of the uterosacral ligaments, and complex free fluid in the pouch of Douglas (cul-de-sac). […] MRI may show an ill-defined adnexal mass containing fluid with various signal intensities.

• #25 Pelvic Inflammatory Disease Workup: Approach Considerations, Laboratory Studies, Transvaginal Ultrasonography

  https://emedicine.medscape.com/article/256448-workup

  Laparoscopy is the criterion standard for the diagnosis of PID. It is significantly more specific and sensitive than are clinical criteria alone. The minimum criteria for diagnosing PID laparoscopically include tubal wall edema, visible hyperemia of the tubal surface, and the presence of exudate on the tubal surfaces and fimbriae. […] Although MRI has relatively high specificity (95%) and sensitivity (95%) in this setting, it is costly and is rarely indicated in cases of acute PID. […] Endometrial biopsy can be used to determine the histopathologic diagnosis of endometritis, a condition that is uniformly associated with salpingitis. Endometrial biopsy is approximately 90% specific and 90% sensitive.

• #26 A Practical Approach to the Diagnosis of Pelvic Inflammatory Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3148590/

  The above approach is sufficient to assure that women with PID will be treated appropriately with antibiotics. […] Although laparoscopy is referred to as the gold standard for the diagnosis of PID, review of the literature regarding its accuracy has been mixed. […] Diagnostic laparoscopy with concomitant endometrial biopsy (subsequently examined histologically) in women with cervicitis will accurately define the continuum of inflammation associated with a clinical diagnosis of PID. […] A purely clinical approach using the findings of lower genital tract inflammation (leukorrhea) associated with pelvic organ tenderness will identify the vast majority of women with PID, and all are candidates for antibiotic therapy.

• #27 Pelvic inflammatory disease (PID) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/pelvic-inflammatory-disease-pid

  Pelvic inflammatory disease (PID) diagnosis may include: a physical examination of your pelvic area to check for tenderness and swelling, blood tests, urine test, swabs of the vagina and cervix, ultrasound (pelvic or transvaginal), laparoscopy in some cases, this is required to correctly diagnose PID. During this procedure, a sample of tissue (biopsy) may be taken. […] If you have any symptoms, see your doctor. Your doctor will do a physical examination and test for possible causes (such as chlamydia and gonorrhoea).

• #28 What is pelvic inflammatory disease (PID)? Causes and treatments

  https://www.invitra.com/en/pelvic-inflammatory-disease/

  Pelvic inflammatory disease (PID) refers to various inflammatory and infectious processes that occur in the upper female genital tract. […] The diagnosis of PID is not very sensitive and specific. There is no single test to diagnose PID, but rather a fundamentally clinical diagnosis will be carried out, which will be complemented by various laboratory tests and other more specialized studies. […] The most common tests for the diagnosis of PID are: Examination of the pelvis for signs of possible pelvic inflammatory disease. Blood count from a blood test that, if PID is present, shows elevated levels of leukocytes. Pelvic ultrasound to look for other possible causes of symptoms such as pregnancy or even appendicitis. Inflammation of the tubes and ovaries is also looked for. Cell culture to confirm the presence of harmful microorganisms on the cervix. Laparoscopy. This is the diagnostic test par excellence, although it has some limitations. It is very useful but the risks and the cost of its implementation must be taken into account. Endometrial biopsy that shows the presence of plasma cells and is indicative of PID.

• #29 Pelvic Inflammatory Disease – Core EM

  https://coreem.net/core/pelvic-inflammatory-disease/

  The diagnosis of PID is primarily clinical: […] A Pelvic exam should be offered and performed in any patient with biologically female anatomy presenting with lower abdominal/pelvic pain. […] Cervical motion tenderness, adnexal tenderness, or uterine tenderness on exam without alternate cause is strongly suggestive of PID and sufficient for establishing diagnosis. […] Less than half of PID patients have classic findings of STI on pelvic exam such as yellow/green purulent vaginal discharge or cervical friability. Absence of these findings should not exclude PID diagnosis. […] Patients with uterine tenderness, cervical motion tenderness, or adnexal tenderness without alternate cause (E.g. ectopic pregnancy or ovarian torsion) should be treated empirically for PID. […] PID remains primarily a clinical diagnosis.

• #30 Pelvic Inflammatory Disease (PID)

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/genital/pelvic-inflammatory-disease/

  Pelvic Inflammatory Disease (PID) is usually the result of infection ascending from the endocervix causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis. Occasionally it is caused by local spread within the peritoneal cavity. […] In patients presenting with any of the symptoms above it is important to consider the diagnosis of PID and take a sexual history. […] A diagnosis of PID should be made on clinical grounds. Do not delay making a diagnosis and initiating treatment whilst waiting for the results of laboratory tests. Negative swab results do not rule out a diagnosis of PID. […] Suspected cases of PID should generally be referred to a GUM clinic. Some patients will need to be referred to the Emergency Department depending on the severity of symptoms.

• #31 Acute pelvic inflammatory disease (PID): tests and treatment | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/acute-pelvic-inflammatory-disease-pid-tests-and-treatment/

  Pelvic inflammatory disease (PID) is an inflammation of the pelvic organs. […] Diagnosis is usually based on symptoms, examination, and test results. […] How is acute PID diagnosed? Your doctor will ask you about your symptoms and your medical and sexual history. […] Swabs may be taken from your vagina and your cervix to test for infection. […] You may be offered blood tests to check for infection. […] If your doctor suspects you have a severe infection, you will be referred to your local hospital for further tests and treatment. […] You will usually be given an injection of an antibiotic followed by a 2 week course of antibiotic tablets. […] If you have a severe infection, you may need an operation under a general anaesthetic called a laparoscopy, which is also called keyhole surgery.

• #32 Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0915/p357.html

  Pelvic inflammatory disease (PID) is an infection of the upper genital tract occurring predominantly in sexually active young women. The diagnosis is made primarily on clinical suspicion, and empiric treatment is recommended in sexually active young women or women at risk for sexually transmitted infections who have unexplained lower abdominal or pelvic pain and cervical motion, uterine, or adnexal tenderness on examination. […] The diagnosis of PID should be made clinically in the absence of other obvious causes in an at-risk woman with unexplained pelvic pain and cervical motion, uterine, or adnexal tenderness. […] The diagnosis of PID is clinical, with imaging and more invasive studies reserved for cases of diagnostic uncertainty or concern for complications (e.g., tubo-ovarian abscess).

• #33 Pelvic Inflammatory Disease – Clinical Features – Management – TeachMeObGyn

  https://teachmeobgyn.com/sexual-health/sexually-transmitted-infections/pelvic-inflammatory-disease/

  Pelvic inflammatory disease (PID) is an infection of the upper genital tract in females, which affects the uterus, fallopian tubes and ovaries. […] It is a relatively common condition, with a diagnosis rate in primary care of approximately 280/100,000 person-years. […] The initial investigations in suspected pelvic inflammatory disease involves identifying the infective organism. […] Endocervical swabs should be taken to test for gonorrhea and chlamydia, and a high vaginal swab for trichomonas vaginalis and bacterial vaginosis. […] Negative swabs do not exclude the diagnosis. […] The mainstay in the management of pelvic inflammatory disease is antibiotic therapy. […] Treatment is a 14-day course of broad spectrum antibiotics with good anaerobic coverage. […] The patient should be advised to rest, and avoid sexual intercourse until the antibiotic course is complete and partner(s) are treated.

• #34 Pelvic inflammatory disease | Healthify

  https://healthify.nz/health-a-z/p/pelvic-inflammatory-disease/

  Pelvic inflammatory disease (PID) is an infection of the female upper reproductive organs in your pelvis. […] Early treatment of PID is important to reduce the risk of serious complications, such as long-term pain and infertility. […] There’s no specific, single test for pelvic inflammatory disease (PID). Your healthcare provider will rely on your symptoms and a physical examination to make a diagnosis. […] If you think you might have PID, tell your doctor or nurse. […] Your healthcare provider will also do blood tests, a urine (pee) test and a vaginal swab to check for the cause of your infection. […] If you have PID, your healthcare provider may refer you to the hospital to have medicines intravenously (through a drip in your arm). […] If your healthcare provider thinks it’s very likely you have PID, you will be given a course of antibiotics, usually before test results come back. […] Make sure you finish the full course of treatment, even if your tests are all clear and you’re feeling better. […] Return to your healthcare provider or clinic for a follow-up check after treatment (usually within 3 days, and again after 1 to 2 weeks).

• #35 Pelvic Inflammatory Disease – Clinical Features – Management – TeachMeObGyn

  https://teachmeobgyn.com/sexual-health/sexually-transmitted-infections/pelvic-inflammatory-disease/

  All sexual partners from the last 6 months should be tested and treated to prevent recurrence and spread of infection. […] Delaying treatment or having repeated episodes of pelvic inflammatory disease (recurrent PID) can increase risks of serious and long term complications. […] Patients should be informed about the potential long-term sequelae of PID.

• #36 Pelvic Inflammatory Disease: Symptoms, Causes, Treatment

  https://www.verywellhealth.com/pelvic-inflammatory-disease-pid-3133135

  Several tests are used in the evaluation of PID. The first is a gynecologic (pelvic) examination. Your healthcare provider examines your vagina and cervix, using a speculum and light to see the area better. […] Specialized diagnostic tests can help your healthcare provider visualize the structure of your reproductive organs and identify any areas of scarring throughout your reproductive tract. […] Pelvic inflammatory disease can be treated and cured when diagnosed early. Antibiotics and surgery are two possible treatment options. […] If PID is detected, antibiotics can be used to target the infection. Typically the antibiotic is selected to provide broad-spectrum coverage of the likely bacteria responsible for the infection. […] Treating PID won’t undo damage it has already caused. And the longer it is allowed to persist, the more likely there will be complications that also need treatment.

• #37 Pelvic Inflammatory Disease (PID): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9129-pelvic-inflammatory-disease-pid

  PID can affect fertility. Of the people who had PID, studies found that 1 in 8 had difficulty getting pregnant. Up to 1 in 10 people ultimately received a diagnosis of infertility. […] Yes, you can get PID again. Getting PID once doesn’t protect you from getting it again. […] If you feel symptoms of PID, see your healthcare provider right away. If you have PID, the most important thing you can do is get treatment.

• #38 Acute pelvic inflammatory disease (PID): tests and treatment | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/acute-pelvic-inflammatory-disease-pid-tests-and-treatment/

  Your doctor may recommend treatment in hospital if your diagnosis is unclear. […] You will usually only need an operation if you have a severe infection or an abscess in the fallopian tube and/or ovary. […] Treatment with antibiotics is usually successful for acute PID. Long-term problems can arise if it is untreated, if treatment is delayed, or if there is a severe infection. […] The long-term effects can include: an increased risk of ectopic pregnancy in the future, difficulties in becoming pregnant, an abscess in a fallopian tube and/or ovary, persistent pain in your lower abdomen.

• #39 Pelvic Inflammatory Disease (PID): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9129-pelvic-inflammatory-disease-pid

  Pelvic inflammatory disease (PID) is an infection that occurs in your uterus, fallopian tubes or ovaries. […] PID develops when certain types of bacteria spread from your vagina to your reproductive organs. […] Getting tested and treated for STIs is the best way to prevent PID. […] If you feel symptoms of PID, see your healthcare provider right away. The sooner you get care, the greater your chances of successful treatment. There isn’t one specific test for PID. Usually, your healthcare provider can diagnose PID through: […] Your provider may also order: […] If you have pelvic inflammatory disease, tell your sexual partner(s). They should receive treatment. Otherwise, you may get PID again when you resume sex. […] If you get prompt diagnosis and treatment for an infection, antibiotics can cure PID. But treatment can’t reverse any damage that already happened to your reproductive organs.

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