Diagnosis and treatment of pelvic inflammatory disease in the emergency room

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Abstract

The incidence of pelvic inflammatory disease in the United States has risen sharply in recent years. Pelvic inflammatory disease poses a direct threat to the future fertility of the woman who contracts it, a threat rendered more serious by the difficulty of making a correct diagnosis and the likelihood that faulty diagnosis will result in inadequate treatment. Diagnostic criteria should include, in addition to the generally accepted signs, at least one of the following: Elevation of temperature, white blood cell count, erythrocyte sedimentation rate; abdominal mass; and/or presence of leukocytes in the peritoneal fluid. The polymicrobial etiology of pelvic inflammatory disease is not yet widely appreciated by clinicians in general practice. Chief among the causative agents is the gonococcus. Also frequently implicated are Peptococcus, Peptostreptococcus, and Bacteroides species. Additionally, Chlamydia trachomatis, whose presence may be masked by the gonococcus, may be a major pathogen. Antibiotic treatment should include agents that are effective against these possible pathogens. Early diagnosis and prompt treatment appear to be crucial in preventing infertility. Patients treated early (if possible within the first two symptomatic days) have a good prognosis, whereas if they are not treated until Day 7, surgical intervention may be necessary, and future fertility is not assured. Contact tracing is particularly important to prevent reinfection and recurrence of pelvic inflammatory disease, since each recurrence is associated with a greater likelihood of infertility.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalSexually Transmitted Diseases
Volume8
Issue numberSuppl. 2
StatePublished - 1981

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ASJC Scopus subject areas

  • Dermatology
  • Microbiology (medical)
  • Public Health, Environmental and Occupational Health

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