Pelvic Inflammatory Disease

Pelvic inflammatory disease can be caused by a number of organisms, including Chlamydia, and presents with pelvic pain and discharge. Findings that contribute to the diagnosis of PID include fever greater than 101 ° F, cervical or vaginal mucopurulent discharge, abundant WBCs on saline preparation of vaginal discharge, elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), and evidence of N. gonorrhoeae or C. trachomatis infection. Hospitaliza-tion with parenteral antibiotics may be necessary in pregnant patients, patients in whom surgical emergency cannot be ruled out, those who do not respond to oral treatment, those who cannot tolerate oral treatment, and patients who have severe illness or tubo-ovarian abscess. When treating PID parenter-ally, improvement of symptoms for 24 hours may prompt a change to oral therapy (Table 16-12). Conversely, if oral therapy is not producing significant improvement within 2 to 3 days, admission for parenteral therapy may be necessary.

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