Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- uterine tenderness
- cervical motion tenderness
- adnexal tenderness
Outros fatores diagnósticos
- lower abdominal pain
- abnormal cervical or vaginal discharge
- fever
Fatores de risco
- prior infection with chlamydia or gonorrhea
- young age at onset of sexual activity
- unprotected sexual intercourse with multiple sexual partners
- prior history of PID
- IUD use
- smoking
- low socioeconomic status
- current vaginal douching
- intercourse during menstruation
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- white blood cell count
- polymorphonuclear cells on wet mount of vaginal secretions
- nucleic acid amplification test for Neisseria gonorrhoeae and Chlamydia trachomatis
- nucleic acid amplification test for Mycoplasma genitalium
Investigações a serem consideradas
- serum erythrocyte sedimentation rate (ESR)
- transvaginal ultrasound
- pelvic CT
- pelvic MRI
- laparoscopy
- endometrial biopsy
Algoritmo de tratamento
suspected or confirmed mild-to-moderate PID at initial presentation
severe PID, complications, or no response to intramuscular/oral therapy
Colaboradores
Autores
Madhavi Manoharan, MD, FRCOG
Consultant Obstetrician and Gynecologist
Integra Healthcare Ltd
Grand Cayman
Cayman Islands
Declarações
MM declares that she has no competing interests.
Agradecimentos
Dr Madhavi Manoharan would like to gratefully acknowledge Dr Dan Selo-Ojeme and Dr Susan Arjmand, previous contributors to this topic.
Declarações
DSO and SA declare that they have no competing interests.
Revisores
Bradford Fenton, MD
Physician
Department of Obstetrics and Gynecology
Summa Health System
Akron
OH
Declarações
BF declares that he has no competing interests.
Edmond Edi-Osagie, MBBS, MRCOG, MD
Consultant Gynaecologist
Central Manchester University Hospitals
St. Mary's Hospital
Manchester
UK
Declarações
EEO declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Texto completo
Ross J, Guaschino S, Cusini M, et al. 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-14.Texto completo Resumo
American College of Radiology. ACR appropriateness criteria: acute pelvic pain in the reproductive age group. 2023 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Ectopic pregnancy
- Acute appendicitis
- Ovarian cyst complications (ruptured ovarian cyst, ovarian cyst torsion, hemorrhagic ovarian cyst)
Mais Diagnósticos diferenciaisDiretrizes
- ACR appropriateness criteria: acute pelvic pain in the reproductive age group
- European guideline on the management of Mycoplasma genitalium infections
Mais DiretrizesFolhetos informativos para os pacientes
Pelvic inflammatory disease
Endometrial ablation (microwave method)
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