Srpski arhiv za celokupno lekarstvo 2010 Volume 138, Issue 9-10, Pages: 658-663
https://doi.org/10.2298/SARH1010658T
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Pelvic inflammatory disease: Contemporary diagnostic and therapeutic approach
Terzić Milan
Kocijančić Dušica
Pelvic inflammatory disease (PID) is polymicrobial infection in women
characterized by inflammation of the upper genital tract, including
endometritis, salpingitis, pelvic peritonitis, occasionally leading to the
formation of tubo-ovarian abscess (TOA). PID primarily affects young,
sexually active women, and it is highly correlated with having several
sexual partners, intrauterine contraceptive device and sexually transmited
diseases. The spectrum of disease is caused most commonly by Chlamydia
trachomatis and Neisseria gonorrhoeae in 30-50% of cases. PID is responsible
for severe acute morbidity and significant long-term sequelae, including
tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The
following clinical features are suggestive of a diagnosis of PID: bilateral
lower abdominal tenderness, abnormal vaginal or cervical discharge, fever
(higher than 38°C), abnormal vaginal bleeding, dyspareunia, cervical motion
tenderness and adnexal tenderness, with or without a palpable mass. In
laboratory findings, there is presence of excess leucocytes, elevated
erythrocyte sedimentation rate or C-reactive protein. Transvaginal
ultrasound scanning may be helpful, and its sensitivity is up to 85%. It can
identify inflamed and dilated tubes and tubo-ovarian masses. Magnetic
resonance imaging can be helpful in a final diagnosis in 95% of cases. In
15-30% of suspected cases, there is no laparoscopic evidence of disease.
Treatment regimens for PID include broadspectrum antibiotics, including
coverage for Neisseria gonorrhoeae and Chlamydia trachomatis. The usage of
parenteral or oral therapy, inpatient or outpatient regimens, depends on the
patient’s clinical condition. Considering the potential complications of
disease, there is a need for good health educational programmes in
reproductive period.
Keywords: pelvic inflammatory disease, tubo-ovarin abscess, diagnosis, treatment
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