A PRACTICAL APPROACH TO THE DIAGNOSIS OF PELVIC INFLAMMATORY DISEASE: The diagnosis of PID is usually based on clinical criteria.Although diagnostic accuracy is advocated,antibiotic therapy should be instituted if there is a diagnosis of cervicitis or suspicion of acute PID. The clinician should maintain a high index of suspicion for the diagnosis as she evaluates the lower genital tract for inflammation and pelvic organs for tenderness in women with genital tract symptoms and a risk for sexually transmitted infections. This approach should minimize treating women without PID with antibiotics and optimize the diagnosis in a practical and cost effective way. Acute PID is associated with cervicitis, endometritis,salpingitis and peritonitis. The sigificant sequelae are tubal factor infertility,ectopic pregnancy and chronic pelvic pain. If pelvic examination fails to reveal evidence of inflammation(if there is no leukorrhoea),then the diagnosis of PID is much less likely and antibiotic treatment can be withheld while the remaining diagnostic workup defines the diagnosis. EVIDENCE OF LOWER GENITAL TRACT INFLAMMATION AND PELVIC ORGAN TENDERNESS SUGGESTS THE ADVISABILITY OF INITIATING THE ANTIMICROBIAL THERAPY SYMPTOMS: 1.Abdominal pain. 2.Abnormal discharge. 3.Metrorrhagia. 4.Post coital bleeding. 5.Fever. 6.Dysuria. 7.Low back ache. 8.Nausea,vomiting. CLINICAL CRITERIA: The diagnosis of PID should be considered in all sexually active women. Abdominal tenderness may/may not be present. Bimanual pelvic examination reveals pelvic organ tenderness. Uterine tenderness=endometritis. Adnexal tenderness=salpingitis. Cervical tenderness=cervicitis. Per speculum examination:look for green/yellow mucopus and friability. Microsopy of vaginal secretions should be performed looking for leucorrhea. (>>1 LEUCOCYTE/EPITHELIAL CELL) Evaluation of bacterial vaginosis (vaginal pH,clue cells&whiff test) Nucleic acid amplification test(NAAT) for gonorrhea and chlamydia should be performed. Empiric antibiotic treatment should be initiated in sexually active women,especially those at risk for STDs with lower abdominal or elvic pain ,if no other causes other than PID can be identified and if the following minimum criteria are present on pelvic examination. 1.Lower genital tract inflammation. cervicitis on clinical examination. More than one leukocyte/epithelial cell on microscopy of vaginal secretions. 2.Pelvic organ tenderness. cervical motion tenderness. Uterine tenderness. Adnexal tenderness.

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Informative

Nice post.

Very useful information. Thanx .

Very Informative mam

Excellent answer sr

PID is very very common as its symptoms are ignored mostly by women due to 1,Ignorence.2,Their very very busy shedules both as housewife or/and working women.3,Shy in joint families. 4,She is little free only in Sunday, when no doctor is available. 5,Family physician continues to give symptomatic treatment for long period of time and the disease becomes chronic.6,Lack of easily accessible toilets.7,Poor personal hygiene of husband and wife. 8,Husbands having sexual contacts with call girls etc.9,Malnourishment leading to anaemia and poor resistance.10,Resistance to the antibiotics.

True, sir
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Informative. Nice

Very useful thanx

Quite useful and informative mam

Thank u mam for sharing

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