Assessment

HISTORY. A thorough history of past infections, a sexual history, and a history of contraceptive use are essential to evaluate a woman with PID. The patient may describe a vaginal discharge, but the characteristics of the discharge (e.g., color, presence of an ordor, consistency, amount) depend on the causative organism. For example, a gonorrhea or staphylococcus infection causes a heavy, purulent discharge. With a streptococcus infection, however, the discharge is thinner with a mucoid consistency. The woman may also experience pain or tenderness, described as aching, cramping, and stabbing, particularly in the lower abdomen or pelvic region, or both. Low back pain may also be present. Other symptoms include dyspareunia (painful sexual intercourse); fever greater than 101°F; general malaise; anorexia; headache; nausea, possibly with vomiting; urinary problems such as dysuria, frequency, urgency, and burning; menstrual irregularity; and constipation or diarrhea.

PHYSICAL EXAMINATION. Observe closely for vaginal discharge and the characteristics of this discharge. Inspect the vulva for signs of maceration. Note if the woman has experienced pruritus that has led to irritated, red skin from scratching. If vomiting is reported, inspect the skin

Pelvic Inflammatory Disease 707

for signs of fluid deficit, such as dryness or poor skin turgor. Rebound tenderness may be noted. When the cervix is manipulated, the woman may complain of pain in this area. Uterine adnexal tenderness is usually present. Auscultate the bowel; at first, the bowel sounds are normal, but as the disease progresses, if it is not treated, the bowel sounds are diminished or even absent if a paralytic ileus is present.

PSYCHOSOCIAL. Because PID may be a life-threatening and life-altering disease, assess the patient's emotional ability to cope with the disease process. In particular, explore the woman's and her partner's concerns about fertility. Because sexual partners need to be treated to prevent reinfection, the patient may have concerns about discussing her illness with her partner or partners.

Diagnostic Highlights

General Comments: A variety of tests, along with clinical symptoms and sexual history, support the diagnosis of PID.

Test

Normal Result

Abnormality with Condition

Explanation

White blood cell (WBC) count

5000-10,000/mm2

>10,500/mm2

Infection and inflammation elicit an increase in WBCs

Erythrocyte sedimentation rate (ESR)

Up to 20/hour

>20 mm/hour

Inflammation increases the protein content of plasma, thus increasing the weight of red blood cells (RBCs) and causing them to descend faster

C-reactive protein (CRP)

Negative to trace

Elevated

Indicates inflammation

Laparoscopy (the gold standard)

Normal-appearing reproductive organs

Pelvic structures are red and inflamed; possible adhesions and scarring

Direct visualization of the pelvic cavity

Falloposcopy

Normal-appearing fallopian tubes

Tubes are red and inflamed; possible adhesions and scarring

Visual inspection of the tubes to detect damage

Other Tests: Transvaginal sonography cal evidence of infection

or MRI; endometrial biopsy with histopathologi-

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