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Guide To PID
|How Is PID Diagnosed?
There is no specific test for PID and a diagnosis is usually only possible once other possible conditions have been ruled out. A typical patient presenting at their doctor with symptoms of pelvic inflammatory disease will complain of painful and heavy periods, painful urination (dysuria) and pain during sexual intercourse (dyspareunia). About 50 percent will have a fever and vaginal discharge. On STD testing, about half will have a gonorrheal or chlamydial infection.
According to the Centers for Disease Control and Prevention (CDC), the minimum requirement for a diagnosis of PID requires the presence of the following:
1. Lower abdominal tenderness.
2. Adnexal tenderness: pain from the ovary and fallopian tube.
3. Cervical motion tenderness (chandelier sign): the patient experiences significant pain in the cervix when it is pressed and manipulated during a physical examination.
The following additional criteria support the doctor's diagnosis:
4. Fever: A temperature over 38.3 C (101F).
5. Abnormal cervical or vaginal discharge.
6. Elevated CRP (C-reactive protein) found in a blood test indicating inflammation.
7. Elevated ESR (erythrocyte sedimentation rate) also found in a blood test indicating inflammation. A C-reactive protein test and ESR blood test are more commonly used in the diagnosis of arthritis.
PID can only be definitively diagnosed by:
8. Endometrial biopsy indicating uterine infection (called endometritis, which is not the same as endometriosis).
9. Ultrasound scan showing thickened fallopian tubes and/or abscesses in the ovaries or fallopian tubes.
10. Laparoscopic surgery which shows abnormalities associated with PID.
At The Doctors
Initially your doctor will perform a pelvic examination and check for any obvious signs of infection, including:
• Vaginal discharge.
• Lumps or masses near or on the ovaries.
• Pain when the cervix or other pelvic organs are pressed on.
If your doctor suspects PID he may prescribe antibiotic therapy at this stage, even without definitive diagnosis, because the risk of developing serious problems if PID is left untreated is very high.
Your doctor will also test for the presence of sexually transmitted diseases, specifically gonorrhea and chlamydia, and possibly HIV and syphilis. You may also be asked to provide a urine sample to check for signs of a urinary tract infection.
If your doctor is still unclear about the diagnosis, he may order more tests to rule out other possible problems like fibroids, endometriosis or ovarian cysts. These tests include:
Ultrasound Scan: Using an imaging tool (usually transvaginal sonography, TVS) he will take internal pictures of the pelvic area. This is a non-invasive test which can help (but not always) to differentiate between endometriosis, ovarian cysts and PID. One study showed magnetic resonance imaging (MRI scan) is more accurate than TVS in diagnosing PID, but MRIs are significantly more expensive.
Endometrial Biopsy: The surgeon removes and tests a small piece of the endometrium (the inside lining of the womb) to check for signs of infection and thickening of the endometrium. Even then, this is nonspecific for PID as this finding can also be seen with uterine polyps, endometrial hyperplasia or endometrial cancer. The patient’s other symptoms need to be taken into account and other signs of infection can help to differentiate.
Laparoscopy: Provides a view of the internal organs. The doctor inserts a small, lighted tube through the stomach to look at the pelvic organs. Ultimately, laparoscopy is the most accurate diagnostic tool.
What Are The Risk Factors For PID?
The risk factors for PID include:
1. Having multiple sexual partners and previous STD infections.
2. Frequent vaginal douching has been considered a risk factor for PID (because the action may push bacteria further into the body), but studies reveal no clear link.
3. Surgical procedures like D&C procedure, endometrial biopsy and hysteroscopy can break the cervical barrier making the woman more prone to infections.
4. Younger women appear to be at increased risk. There are a number of possible reasons for this including:
• Cervical mucus (the substance that blocks bacteria from entering the womb) has not sufficiently thickened.
• Lower level of protective chlamydia antibodies. Read about the causes of pelvic inflammatory disease and the STD link.
• More likely to demonstrate risk-taking behaviors (sleeping with more partners, not using condoms and so on).
5. Bacterial vaginosis (BV) may (but this is controversial) play a role in the initial infection of some women with PID. These women typically have a heavy growth of BV-associated organisms like G vaginalis, have had more than 2 sexual partners and may have recently had an abortion procedure or undergone gynecologic surgery.
Next: Treatment for pelvic inflammatory disease.