Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Recall the various infectious disorders that are included in PID 2. Identify the clinical signs, observations and blood/culture results in patients with PID
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
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
Sexually active and/or at risk: adolescents, women attending STD clinics, those in communities with high rates of gonorrhea or chlamydia
One or more of the following on pelvic exam:
Cervical motion tenderness (CMT)
Other causes (ectopic pregnancy, ovarian cyst, appendicitis, functional pain) are unlikely
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)
Elevated C-reactive protein (CRP)
Positive gonorrhea/chlamydia trachomatis culture
Most specific criteria for diagnosing PID
Endometrial biopsy for evidence of endometritis
Transvaginal ultrasound or MRI demonstrating thickened fluid filled fallopian tubes, or tubo-ovarian collection, or tubal hyperemia
Laparoscopic findings consistent with PID
The CDC cautions that laparoscopy “is not easily justifiable when symptoms are mild or vague. Moreover, laparoscopy will not detect endometritis and might not detect subtle inflammation of the fallopian tubes.”
Pelvic inflammatory disease comprises a spectrum of disorders ranging from asymptomatic to debilitating. Acute PID may be difficult to diagnose because of the wide variation in symptoms and signs. The diagnosis of PID is usually based on clinical findings noted above.
Wet Prep (saline preparation of vaginal fluid)
Most women with PID have either mucopurulent cervical discharge or evidence of WBCs on a microscopic evaluation
If the cervical discharge appears normal and no WBCs are observed on the wet prep of vaginal fluid, the diagnosis of PID is unlikely
Consider alternative causes of pain
A wet prep of vaginal fluid also can detect the presence of concomitant infections (e.g., BV and trichomoniasis)
PID is usually, but not always, seen in the presence of gonorrhea or chlamydia trachomatis infections
Typical vaginal flora, cytomegalovirus, mycoplasma may be associated with PID
Many episodes of PID go unrecognized with potential long-term sequelae of infertility or chronic pain
Healthcare providers should maintain a low threshold for the diagnosis of PID
It is better to overtreat than to undertreat
All women diagnosed with PID should be tested for HIV as well as gonorrhea and chlamydia
Treatment should not be delayed until test results are available if there is a clinical suspicion of PID
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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