Complications
Can occur with untreated Neisseria gonorrhoeae or Chlamydia trachomatis infections (40% risk).
Clinical diagnostic criteria are used for the diagnosis of PID. Pelvic examination and pelvic ultrasound should be performed in any patient with suspected or confirmed PID to assess for tubo-ovarian abscess.
Antibiotic coverage should be expanded, and hospital admission should be considered for nulliparous or non-compliant patients.[1]
Can occur with untreated PID.
Admission to hospital and expanded antibiotic coverage are recommended.[1]
Pelvic examination and pelvic ultrasound should be performed in any patient with suspected or confirmed PID to assess for TOA.
Patients who fail conservative management with parenteral antibiotics or who present with a ruptured TOA/sepsis may require percutaneous drainage by an interventional radiologist or exploration by a surgeon.
Ectopic pregnancies can occur with tubal damage following PID. Risk increases with each subsequent infection.
The physician should treat with conservative medical or surgical management as appropriate, given the stage of pregnancy and clinical condition of the patient.
Infertility can be caused by tubal obstruction or impaired motility following PID.
A complete infertility work-up should be performed, including evaluation of tubal patency, in any such patient presenting to an infertility clinic.
Untreated Chlamydia trachomatis (often asymptomatic) carries a 20% risk of subsequent infertility. Risk increases with subsequent infections.
Whether it is due to chronic inflammation or adhesive processes, the risk increases with each subsequent episode.
If patients have been treated for an infectious aetiology but have persistent signs of cervicitis, non-infectious aetiologies must be considered.
All chemical irritants (such as spermicides or vaginal douches) should be avoided.
Repeat cultures or nucleic acid amplification testing can be performed but may have decreased sensitivity if done within 3 weeks of the original infection, particularly for Chlamydia trachomatis. Bacterial vaginosis may be confirmed by microscopy, pH of vaginal discharge, and amine odour.
In some cases of non-infectious chronic cervicitis, surgical excision (using electrosurgery or laser) or microwave ablation may be indicated.[33]
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