Pelvic Inflammatory Disease Discussion Post

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Pelvic Inflammatory Disease Discussion Post

Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration.

History includes:

LMP 2 weeks ago (regular)
Reports oral contraceptive use
Reports pain in lower abdomen with cramping and pain on urination for 3 days
Denies any GI problems, reports regular bowel movements. Pelvic Inflammatory Disease Discussion Post

 

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Denies vaginal discharge
Ann is married and in a monogamous relationship. Has one child age 2
Reports no use of condoms/sexual intercourse 2-3 times per week
Denies any history of STDs

Physical Exam reveals:

Temp 100. 6, P 80 BP 100/62 Wt. 125 Ht. 5’3’’
HEENT WNL
No CVA tenderness
Pain in lower quadrants with light palpation. Positive inguinal lymphadenopathy
External genitalia without lesions or discharge
Pelvic exam reveals minimal cervical mucopus
Bimanual exam reveals uterine and adnexal tenderness and cervical motion pain. Uterus anterior, midline, smooth, not enlarged

1. Based on the above case the diagnosis is PID,  What is an appropriate CDC-recommended therapeutic regimen for this patient?

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  • The optimal treatment regimen and long-term outcome of early treatment of women with subclinical PID are unknown. All regimens used to treat PID should also be effective against N. gonorrhoeae and C. trachomatis because negative endocervical screening for these organisms does not rule out upper-reproductive–tract infection. The need to eradicate anaerobes from women who have PID has not been determined definitively. Anaerobic bacteria have been isolated from the upper-reproductive tract of women who have PID, and data from in vitro studies have revealed that some anaerobes (e.g., Bacteroides fragilis) can cause tubal and epithelial destruction. BV is present in many women who have PID. Until treatment regimens that do not cover anaerobic microbes have been demonstrated to prevent long-term sequelae (e.g., infertility and ectopic pregnancy) as successfully as the regimens that are effective against these microbes, the use of regimens with anaerobic activity should be considered. Treatment should be initiated as soon as the presumptive diagnosis has been made, because prevention of long-term sequelae is dependent on early administration of appropriate antibiotics (CDC.gov,2015). Pelvic Inflammatory Disease Discussion Post
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  • Cassie Fritzinger posted Mar 7, 2021 12:13 AM
  •            Pelvic Inflammatory Disease (PID) is the inflammation of the pelvic tissue/organs in the upper genital tract, which is caused by infection often untreated sexually transmitted diseases (STDs) (Heuther, McCance, & Brashers, 2020).  According to the Center for Disease Control and Prevention (CDC), 1 in 8 women with a history of PID will have difficulty successfully getting pregnant. PID can be treated, however the patient will have scarring secondary to the infectious process which can cause damage to the reproductive system. When treatment is delayed this damage can cause infertility, future ectopic pregnancies, or other damage to areas of the reproductive system (Center for Disease Control and Prevention, 2017).            Our case presentation meets the clinical criteria of cervical motion and uterine tenderness as well as adnexal tenderness, and thus could be treated with the initiation of empiric for presumed PID. An important fact about the empiric treatment of PID is that treatment should be a broad-spectrum coverage, and it should also be effective against N. gonorrhoeae and C. trachomatis even if endocervical screening is negative as this does not rule out upper-reproductive-tract infections. It is important to get the patient started on treatment at the earliest availability so there is limited long-term damage. Also, Zhou et al, (2017) report that PID has been found to have an increased risk of ovarian cancer. Since the patient is not critically ill, and does not warrant any surgical interventions, outpatient oral therapy could be started on this patient. The recommended treatment options include the following: ceftriaxone IM & doxycycline (with or without metronidazole), or cefoxitin IM with probenecid & doxycycline (with or without metronidazole), or another parenteral 3rd generation cephalosporin & doxycycline (with or without metronidazole) (Center for Disease Control and Prevention, 2017).  Center for Disease Control and Prevention. (2017). Pelvic Inflammatory Disease (PID). Retrieved March 6, 2021 from https://www.cdc.gov/std/pid/default.htmHeuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier. less0 UnreadUnread
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  • Zhou, Z., Zeng, F., Yuan, J., Tang, J., Colditz, G., Tworoger, S., Trabert, B. & Su, X. (2017). Pelvic Inflammatory Disease and the Risk of Ovarian Cancer: A Meta-Analysis. Cancer Causes Control. 28: 415-428. Doi:10.1007/s10552-017-0873-3
  • Hentour, K., Millet, I., Pages-Bouic, E., Curros-Doyon, F., Molinari, N., & Taourel, P. (2017). How to Differentiate Acute Pelvic Inflammatory Disease from Acute Appendicitis? A Decision Tree Based on CT Findings. European Society of Radiology. 28:673-682 Doi:10.1007/s00330-017-5032-4 Pelvic Inflammatory Disease Discussion Post
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  •             Women who are treated for PID should have a follow-up appointment and should demonstrate clinical improvement within 3 days of starting treatment therapy. If the patient does not have clinical improvement the patient should be admitted to the hospital and further treatment and diagnostic testing should be performed. Those with chlamydial or gonococcal PID should be retested in 3mth or at their next medical exam. The patient in our case study reports being in a monogamous relationship. It is important to also treat her husband presumptively for chlamydia and gonorrhea regardless of symptomology or the etiology of PID. The couple should abstain from sexual contact until both parties have completed therapy and all symptoms have resolved (Center for Disease Control and Prevention, 2017).
  •             PID can be difficult to differentiate from other abdominal/pelvic condition since symptoms are often vague and there is a wide range of symptoms the patient may experience. Other conditions such as acute appendicitis, ovarian cysts, ectopic pregnancy, and other functional pain should be ruled out (Center for Disease Control and Prevention, 2017). Hentour et al. (2017), reports that inaccurate diagnosis of PID has been made with cervical or uterine motion tenderness, adnexal tenderness, elevated C-Reactive Protein (CRP) and leukocytes which can also be found in acute appendicitis. Pelvic ultrasound or a computed tomography (CT) may be performed when there is a non-specific symptomology especially if acute appendicitis is suspected. This would assist with ensuring an acute appendicitis is not missed and surgical intervention is not delay should it be required (Hentour et al., 2017). However, it is suggested that any women diagnosed with PID should be tested for HIV, gonorrhea, and chlamydia using a nucleic acid amplification test (Center for Disease Control and Prevention, 2017). Pelvic Inflammatory Disease Discussion Post
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  • Tallona Boddy posted Mar 8, 2021 8:57 PM
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  • Pelvic inflammatory disease (PID) is the inflammation of female reproductive organs due to a bacterial infection spread through sexual contact. The signs and symptoms of PID are often vague and/or generalized which can make diagnosis more difficult.  The signs and symptoms of PID can also go unnoticed until significant inflammation has occurred which can then lead to long-term complications for example, infertility or pelvic pain (Mayo Clinic, n.d.). Ann presents as a 32 year old female with no other stated complications such as tubo-ovarian abscess, severe vomiting, or pregnancy.  Based off of the stated findings, Ann is an appropriate candidate for a PO/IM regimen.  The regimen includes, ceftriaxone 250 mg IM in a single dose, plus coxycycline 100 mg orally twice a day for 14 days with metronidazole 500 mg orally twice a day for 14 days.  Another possible regimen is cefoxitin 2 g IM in a single dose and probenecid, 1 g orally administered concurrently in a single dose, plus doxycycline 100 mg orally twice a day for 14 days with metronidazole 500 mg orally twice a day for 14 days.  If the cultures for any of the sexually transmitted diseases comes back positive, the regimen should then be based off of the microbial results (Centers for Disease, 2015).  Centers for Disease Control and Prevention. (2015 June, 4). 2015 Sexually transmitted diseases treatment guidelines. https://www.cdc.gov/std/tg2015/pid.htm Pelvic Inflammatory Disease Discussion Post