Diagnosis

A. The diagnosis of PID relies on a high index of suspicion. PID is correctly diagnosed on the basis of clinical and laboratory indicators in only 65% of cases. Therefore, a low threshold for initiating empiric antibiotics is essential.

B. Risk factors include multiple sex partners, frequent sexual intercourse, and a new sexual partner within the previous 3 months.

C. PID is characterized by diffuse lower abdominal pain that is often dull and constant, usually bilateral, and less than 2 weeks in duration.

D. An abnormal vaginal discharge, abnormal bleeding, dysuria, dyspareunia, nausea, vomiting or fever may be present. PID is more likely to begin during the first half of the menstrual cycle.

E. Abdominal tenderness, adnexal tenderness and cervical motion tenderness are the most frequently observed findings. The presence of symptoms, lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness is sufficient to justify beginning empiric therapy for suspected PID.

Differential Diagnosis of Pelvic Inflammatory Disease

Appendicitis

Irritable bowel syndrome

Ectopic pregnancy

Somatization

Hemorrhagic ovarian cyst

Gastroenteritis

Ovarian torsion

Cholecystitis

Endometriosis

Nephrolithiasis

Urinary tract Infection

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