Diagnosis of Pelvic Inflammatory Disease

Pelvic Inflammatory disease (PID) is an infection that occurs in the female reproductive tract and is usually caused by a bacterial infection. Women experience symptoms such as nausea, fever, pain on urination, painful menstruation, pain during intercourse, heavy periods or bleeding after intercourse.

PID isn’t diagnosed solely by symptoms alone however. This is because most of the symptoms are also symptoms of other conditions. For instance, nausea, fever, pain on urination and urethritis are all symptoms of both PID and a urinary tract infection.

The symptoms of PID can also mimic genital herpes, vaginitis, endometriosis, fibroids, dyspareunia, cervicitis, acute appendicitis and ovarian cysts. Women and doctors must be diligent in their efforts to determine the exact cause of the symptoms so that other more immediate problems may be addressed (acute appendicitis) and not overlooked.

Failure to diagnose PID can lead to infertility, ectopic pregnancy (leading cause of death in women in the 1st trimester of pregnancy) and anemia. For some women there are no early signs or symptoms of the disease and therefore no reason to see their medical practitioner.

Once at the physician’s office there will be several things the physician will use to help diagnose PID. They will first take a thorough history from the woman asking questions about the length of time she has experienced these symptoms, other symptoms she may have experienced and her sexual history.

After the history the doctor will do a physical examination looking for painful areas in the pelvic region, swollen uterus, signs of infection in the fallopian tubes and ovaries. The pelvic examination will also include a scraping from the cervix for a culture. Up to 40% of women with untreated Chlamydia will develop PID. This particular organism will still be present on the cervix of the woman and will culture out in the laboratory.

The physician will also do a screen for a urinary tract infection (UTI) if the woman presents with symptoms that are similar — painful urination, vomiting, fever and urethritis. If the screening for a UTI is negative they will probably send a culture but will also search for the answer using other means such as a culture of the vaginal discharge, ultrasound of the abdomen and endometrial biopsy.

The culture of vaginal discharge can be taken at the same time as the culture of the cervical cells. During the office visit the physician may also do an abdominal ultrasound looking for signs of infection in the reproductive tissue. This is the same type of ultrasound machine used for the sonogram done during pregnancy. It is painless, noninvasive and easily accomplished in the office.

If the woman has symptoms of an infection, the cultures come back negative and the ultrasound is non equivocal then the physician may decide to perform an endometrial biopsy to totally rule out PID. This procedure is done as an outpatient examination requiring anesthesia.

Other predisposing conditions that can trigger PID are an abortion, insertion of an IUD, childbirth and recent appendix surgery. With these situations in the recent past history of the woman the physician may decide to try treatment first instead of a biopsy. Researchers have also found that PID that doesn’t respond to treatment can indicate an infection with HIV.


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