2. Q2 PID
A 22 years woman presents to the A&E with complaint of pain lower abdomen for 3 days. She is sexually active with her partner for the last 3 months, but does not use any contraceptive. She is generally well, and afebrile. The pregnancy test is negative and a urine dipstick is normal. On bimanual palpation, there is local tenderness in left adnexa. Empirical antibiotics should be offered to her-
A diagnosis of PID should be considered, and usually empirical antibiotic treatment offered, in any
-sexually active woman who has
- recent onset, lower abdominal pain associated with
- local tenderness on bimanual vaginal examination
- in whom pregnancy has been excluded and
- no other cause for the pain has been identified.
The risk of PID is highest in women aged under 25 not using barrier contraception and with a history of a new sexual partner. The diagnosis of PID based only on positive examination findings, in the absence of lower abdominal pain, should only be made with caution.
It is likely that delaying treatment increases the risk of long term sequelae such as ectopic pregnancy,infertility and pelvic pain. Because of this, and the lack of definitive diagnostic criteria, a low threshold for empiric treatment of PID is recommended.Â
