Physical examination

A. Only one-half of patients with PID have fever. Abdominal examination reveals diffuse tenderness greatest in the lower quadrants, which may or may not be symmetrical. Rebound tenderness and decreased bowel sounds are common. Tenderness in the right upper quadrant does not exclude PID, because approximately 10 percent of these pa tients have perihepatitis (Fitz-Hugh Curtis syndrome).

B. Purulent endocervical discharge and/or acute cervical motion and adnexal tenderness by bimanual examination is strongly suggestive of PID. Rectovaginal examination should reveal the uterine adnexal tenderness.

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