eMedicine Specialties > Obstetrics and Gynecology > Infections

Pelvic Inflammatory Disease: Differential Diagnoses & Workup

Author: James B Hill, MD, Chief, Division of Obstetrics, Staff Physician, Department of Obstetrics and Gynecology, Womack Army Medical Center
Coauthor(s): Ernest Lockrow, DO, Chief of Gynecology Service, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center; Assistant Professor, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Aug 27, 2009

Differential Diagnoses

Adnexal Tumors
Appendicitis
Ectopic Pregnancy
Endometriosis

Other Problems to Be Considered

Rupture of an adnexal mass
Adnexal torsion
Perihepatic inflammation (Fitz-Hugh and Curtis syndrome)

Workup

Laboratory Studies

  • Additional criteria may be used to increase the specificity of the diagnosis as listed below.
  • Vaginal wet mount - Increased amount of white cells
  • Erythrocyte sedimentation rate (ESR) - Elevated, nonspecific
  • C-reactive protein (CRP) - Elevated, nonspecific
  • CBC count - Elevated white blood cell count
  • Gonorrhea cultures - Generally used to confirm diagnosis (frequently negative in later stages)
  • Chlamydial cultures - Generally used to confirm diagnosis (large variability in recovery from cervix [5-56%])

Imaging Studies

  • Transvaginal sonography may not be useful in the diagnosis of PID.5 It has poor sensitivity (81%) and specificity (78%) with mild or atypical PID. It can be used to document an adnexal mass or demonstrate fluid-filled fallopian tubes.
  • Although the specificity (95%) and sensitivity (95%) of MRI is relatively high, it is costly and rarely indicated in acute PID. If used in the management of PID, MRI can demonstrate thickened fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex.

Procedures

Culdocentesis: With the advent of transvaginal sonography, culdocentesis is rarely performed. In the absence of current technology, insertion of an 18-gauge spinal needle attached to a syringe can be performed. The needle is inserted transvaginally into the cul-de-sac, yielding either purulent fluid or bloody fluid from the peritoneum.

More on Pelvic Inflammatory Disease

Overview: Pelvic Inflammatory Disease
Differential Diagnoses & Workup: Pelvic Inflammatory Disease
Treatment & Medication: Pelvic Inflammatory Disease
Follow-up: Pelvic Inflammatory Disease
References
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References

  1. Sorbye IK, Jerve F, Staff AC. Reduction in hospitalized women with pelvic inflammatory disease in Oslo over the past decade. Acta Obstet Gynecol Scand. Mar 2005;84(3):290-6. [Medline].

  2. Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Murray P, et al. The demographic, sexual health and behavioral correlates of Mycoplasma genitalium infection among women with clinically suspected pelvic inflammatory disease. Sex Transm Infect. Aug 24 2009;[Medline].

  3. Bakken IJ, Ghaderi S. Incidence of pelvic inflammatory disease in a large cohort of women tested for Chlamydia trachomatis: a historical follow-up study. BMC Infect Dis. Aug 14 2009;9(1):130. [Medline].

  4. Ross JD. Is Mycoplasma genitalium a cause of pelvic inflammatory disease?. Infect Dis Clin North Am. Jun 2005;19(2):407-13. [Medline].

  5. Tukeva TA, Aronen HJ, Karjalainen PT, et al. MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Radiology. Jan 1999;210(1):209-16. [Medline].

  6. [Guideline] CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94. [Medline]. [Full Text].

  7. [Guideline] CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. Apr 13 2007;56(14):332-6. [Medline].

  8. Aledort JE, Hook EW, Weinstein MC, Goldie SJ. The cost effectiveness of gonorrhea screening in urban emergency departments. Sex Transm Dis. Jul 2005;32(7):425-36. [Medline].

  9. Cohen CR, Sinei S, Reilly M, et al. Effect of human immunodeficiency virus type 1 infection upon acute salpingitis: a laparoscopic study. J Infect Dis. Nov 1998;178(5):1352-8. [Medline].

  10. Coonrod D, Collier AC, Ashley R, et al. Association between cytomegalovirus seroconversion and upper genital tract infection among women attending a sexually transmitted disease clinic: a prospective study. J Infect Dis. May 1998;177(5):1188-93. [Medline].

  11. Hillis SD, Owens LM, Marchbanks PA, et al. Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease. Am J Obstet Gynecol. Jan 1997;176(1 Pt 1):103-7. [Medline].

  12. Howell MR, Kassler WJ, Haddix A. Partner notification to prevent pelvic inflammatory disease in women. Cost-effectiveness of two strategies. Sex Transm Dis. May 1997;24(5):287-92. [Medline].

  13. Howell MR, Quinn TC, Brathwaite W, et al. Screening women for chlamydia trachomatis in family planning clinics: the cost-effectiveness of DNA amplification assays. Sex Transm Dis. Feb 1998;25(2):108-17. [Medline].

  14. Irwin KL, Moorman AC, O'Sullivan MJ, Sperling R, Koestler ME, Soto I, et al. Influence of human immunodeficiency virus infection on pelvic inflammatory disease. Obstet Gynecol. Apr 2000;95(4):525-34. [Medline].

  15. Jamieson DJ, Duerr A, Macasaet MA, et al. Risk factors for a complicated clinical course among women hospitalized with pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2000;8(2):88-93. [Medline].

  16. Peipert JF, Ness RB, Soper DE. Association of lower genital tract inflammation with objective evidence of endometritis. Infect Dis Obstet Gynecol. 2000;8(2):83-7. [Medline].

  17. Peipert JF, Sweet RL, Walker CK, Bass D. Evaluation of ofloxacin in the treatment of laparoscopically documented acute pelvic inflammatory disease (salpingitis). Infect Dis Obstet Gynecol. 1999;7(3):138-44. [Medline].

  18. Rock JA, Thompson JD. Telinde's Operative Gynecology. 1997. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins Publishers; 657-684.

  19. Scholes D, Stergachis A, Heidrich FE, et al. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. May 23 1996;334(21):1362-6. [Medline].

  20. Wiesenfeld HC, Sweet RL, Ness RB, et al. Comparison of acute and subclinical pelvic inflammatory disease. Sex Transm Dis. Jul 2005;32(7):400-5. [Medline].

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Further Reading

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Keywords

pelvic inflammatory disease, PID, uterus, fallopian tubes, intrauterine device, IUD, tubal infertility, genital tract, vagina, cervix, sexually transmitted diseases, STD, ectopic pregnancy, tubal pregnancy, pelvic pain, dysuria, vaginal discharge, vaginal bleeding, Chlamydia trachomatis, C trachomatis, Gardnerella vaginalis, G vaginalis, Haemophilus influenzae, H influenzae, Escherichia coli, E coli, Peptococcus species, Streptococcus agalactiae, S agalactiae, Bacteroides fragilis, B fragilis, Neisseria gonorrhoeae, N gonorrhoeae, Mycoplasma genitalium, M genitalium, cytomegalovirus, CMV, endogenous microflora

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Contributor Information and Disclosures

Author

James B Hill, MD, Chief, Division of Obstetrics, Staff Physician, Department of Obstetrics and Gynecology, Womack Army Medical Center
James B Hill, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ernest Lockrow, DO, Chief of Gynecology Service, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center; Assistant Professor, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences
Ernest Lockrow, DO is a member of the following medical societies: American College of Obstetricians and Gynecologists
Disclosure: Nothing to disclose.

Medical Editor

Ronald Levine, MD, Director, Section of Gynecologic Endoscopy, Professor, Department of Obstetrics and Gynecology, University of Louisville School of Medicine
Ronald Levine, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Obstetricians and Gynecologists, American Medical Association, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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