• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
GYN
CMECNE

The ABCs of PID Diagnosis – What You Need to Know

image_pdfFavoriteLoadingFavorite

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

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

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.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

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:

  1. Sexually active and/or at risk: adolescents, women attending STD clinics, those in communities with high rates of gonorrhea or chlamydia
  2. One or more of the following on pelvic exam:
    1. Cervical motion tenderness (CMT)
    2. Uterine tenderness
    3. Adnexal tenderness
  3. Other causes (ectopic pregnancy, ovarian cyst, appendicitis, functional pain) are unlikely

Additional criteria to support the diagnosis of PID:

  1. Oral temperature >101°F (>38.3°C)
  2. Abnormal cervical mucopurulent discharge or cervical friability
  3. Abundant WBCs on saline microscopy of vaginal fluid
  4. Elevated erythrocyte sedimentation rate (ESR)
  5. Elevated C-reactive protein (CRP)
  6. Positive gonorrhea/chlamydia trachomatis culture

Most specific criteria for diagnosing PID:

  1. Endometrial biopsy for evidence of endometritis
  2. Transvaginal ultrasound or MRI demonstrating thickened fluid filled fallopian tubes, or tubo-ovarian collection, or tubal hyperemia
  3. Laparoscopic findings consistent with PID

SYNOPSIS:

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.

KEY POINTS:

  • 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

Learn More – Primary Sources:

CDC 2015 Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID) 

Take a post-test and get CME credits

TAKE THE POST TEST

Want to hear about the latest clinical summaries via ObG Insider?

Get Your Free e-Newsletter »

image_pdfFavoriteLoadingFavorite

< Previous
All GYN Posts
Next >

Related ObG Topics:

Pelvic Inflammatory Disease – CDC Treatment Guidelines
Gonorrhea: New CDC Diagnosis and Treatment Guidelines
Gonorrhea Treatment Pearls
Chlamydia: CDC Recommendations for Diagnosis and Treatment

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

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.

Disclaimer

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.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site