Pelvic Inflammatory Disease & Tubo-ovarian Abscess

Before we get to the meat of today’s topic… we’re pleased to announce a partnership with the OBG Project. They have excellent resources, and a new product called OBG First. PGY-4 residents can get OBG First for one year for absolutely free — check out the website and follow the instructions, and a coupon code will get sent to your inbox.

And now for PID! The CDC guidelines, as always, are super helpful further reading.

The diagnosis of PID can be challenging. In the absence of other causes, one of the following three findings must be present:
- Cervical motion tenderness
- Uterine tenderness
- Adnexal tenderness

There are several additional criteria that can enhance the specificity of diagnosis:
- Oral temp > 101 F (38.3)
- Abnormal cervical mucopurulent discharge or friability
- Presence of abundant WBC on saline microscopy of vaginal fluid
- Elevated erythrocyte sedimentation rate
- Elevated C-reactive protein
- Laboratory documentation of cervical infection with N. gonorrhoaea or C. trachomatis

Even more specific criteria include certain other tests, including:
- Endometrial biopsy with histopathologic evidence of endometritis
- TVUS or MRI showing thickened, fluid-filled tubes with or without free fluid, or tubo-ovarian complex
- Laparoscopic findings of PID (remember Fitz-Hugh-Curtis?)

We review indications for hospitalization versus outpatient treatment for PID, but the big ones to remember include:
- Inability to exclude other surgical emergencies
- Pregnancy
- Severe illness
- Inability to tolerate or follow outpatient therapy,
- Failed response to outpatient therapy in 48-72 hours.

Finally, we go over treatments for PID, straight from the CDC:

CDC STD 2015 Guidelines.

CDC 2015 STD Guidelines.

And remember:
- Clinical follow up should be arranged in 48-72 hours after hospitalization or after initiation of outpatient therapy, to ensure response.
- Tubo-ovarian abscess < 10 cm rarely need surgical intervention. However, percutaneous drainage is an option that often does help to expedite response to therapy.

Further reading from the OBG Project:
- Unexplained Pelvic Pain
- CDC treatment guidelines
- The ABCs of PID Diagnosis

Gonorrhea and Chlamydia

Though CREOGs are over, we hope you continue to study with us! On today’s episode we tackle chlamydia and gonorrhea.

The most helpful resource we mention on today’s episode comes from the CDC’s 2015 STD Treatment Guidelines. They even have a free smartphone app, which is very handy for use in your emergency department or clinic/office setting.

Gonorrhea is caused by the gram negative diplococcus Neisseria gonorrhoeae. Chlamydia is an obligate intracellular gram negative pathogen. Below we’ve created our own guides to treatment based on the CDC recommendations. Happy listening!