Primary Health Care of Family IV
A patient that is 32 yo and has been married to her husband for 10 years, come in complaining of pelvic pain that is new, constant and worsening for about 3 weeks. She states she did not come in sooner because her husband works out of town for long periods and she did not have anyone to take care of their 3 children while she comes in to see you. He is home now and they tried having sex last night but she stated it was too painful and they had to stop. She reports a small amount of post-coital bleeding after their attempt. She states she has not had this kind of pain before but denies any dysuria or problems with defecation with this pain. She also denies any GI symptoms at this time. Her Temp is 100.3 today, P 82, BP 102/74, O2 SAT100%. Abdominal exam negative for HSM or any mass, but mild LQT noted without guarding. Pelvic exam reveals normal external genitalia, vaginal walls pink and a moderate amount of thin gray vaginal discharge is noted in the posterior fornix, but otherwise normal. Bimanual exam is significant for positive CMT and left adnexal pain.
CC: “I have pain in my pelvis”.
1. What is the differential diagnosis for this scenario?
2. What are the most common organisms that can cause PID?
3. What are the presenting symptoms of PID?
4. What test need to be performed to get a definitive diagnosis of PID?
5. How do you manage PID?
6. What teaching and follow-up is needed in PID?
What is the differential diagnosis for this scenario?
Several conditions can cause pelvic pain in women. For this case, some of the differential diagnoses can be pelvic inflammatory disease, ovarian torsion, appendicitis, ectopic pregnancy, and ruptured ovarian cyst (Curry et al., 2019).
What are the most common organisms that can cause PID?
Pelvic inflammatory disease (PID) is a female reproductive infection that is associated with several microorganisms. Chlamydia trachomatis and Neisseria gonorrhoeae have been associated with approximately 75% of all PID infections cases and are considered the primary causes of PID. However, other endogenous microorganisms, including gram-positive and negative bacteria, anaerobic and aerobic gram-positive and negative cocci, and rods commonly found in women with vaginosis, have also been associated with PID pathogenesis. For example, New research has also associated Mycoplasma genitalium, microorganisms found in the lower genital tract, with PID, although it has only been shown to cause milder symptoms (Mitchell et al., 2021).
What are the presenting symptoms of PID?
Patients with pelvic inflammatory disease can present with various symptoms ranging from unnoticeable, to mild and at times, they can be severe. Some of the symptoms that a patient is likely to observe include fever that is more than 38.3° C, lower abdominal pain and pelvic pain that can be mild or severe, pain with intercourse, abdominal tenderness, frequent and painful urination, Adnexal and pelvic tenderness, unusual vaginal discharge mostly yellow or green irregular and painful menstrual bleeding and cervical motion tenderness (Mitchell et al., 2021).
What test need to be performed to get a definitive diagnosis of PID?
Due to the wide range of symptoms associated with pelvic inflammatory disease, no single test is sensitive enough to be used to provide a definitive PID diagnosis. It is thus diagnosed based on gynecological examination and the symptoms exhibited by the patient. On clinical examination, some of the minimum clinical findings, including uterine, adnexal, and cervical motion tenderness, must be present for PID diagnosis. To enhance the minimum criteria, one of the other symptoms mentioned above can also be assessed for. Other criteria to ensure a specific diagnosis of PID include transvaginal magnetic resonance imaging (sonography) that shows fluid-filled tubes or indicates tubo-ovarian complex (Curry et al., 2019).