Question

Discuss the clinical features and investigations in a case of acute PID.

Hint:

Fever, pelvic pain, and cervical motion tenderness are key clinical features of acute PID. Investigations should focus on identifying the causative organisms.

Answer 1

Step 1: Clinical Features of Acute PID.
The clinical presentation of acute PID varies, but the most common symptoms include:
(1) Pelvic Pain:
- Dull, aching lower abdominal pain or pelvic pain that is usually bilateral. The pain can be sudden and severe in some cases.
- Pain may increase with sexual intercourse or during pelvic examination.
(2) Fever and Malaise:
- Fever (usually >38° is common and often accompanies the infection.
- Malaise, fatigue, and general ill-feeling are also frequently reported.
(3) Vaginal Discharge:
- Abnormal vaginal discharge, often foul-smelling, which may be purulent or mucopurulent.
- Increased white blood cell count in the discharge.
(4) Dysuria and Dyspareunia:
- Painful urination (dysuri and pain during intercourse (dyspareuni are also symptoms.
(5) Abnormal Menstrual Bleeding:
- Irregular bleeding or spotting between periods may occur.
Step 2: Investigations in Acute PID.
(1) Clinical Examination:
- Tenderness on bimanual pelvic examination, particularly in the adnexa (ovaries and fallopian tubes).
- Cervical motion tenderness (CMT) is a classic sign of PID.
(2) Microbiological Tests:
- Endocervical swabs for Neisseria gonorrhoeae and Chlamydia trachomatis.
- Vaginal discharge cultures to identify other pathogens like Escherichia coli or Mycoplasma genitalium.
(3) Ultrasound:
- Pelvic ultrasound may show signs of tubal and ovarian abscesses, thickened fallopian tubes, and free pelvic fluid (which suggests inflammation).
(4) Laboratory Tests:
- Blood tests may reveal leukocytosis (elevated white blood cell count) and elevated C-reactive protein (CRP).
(5) Laparoscopy (If Neede:
- In severe or complicated cases, laparoscopy may be performed to directly visualize the pelvic organs and assess the extent of damage or infection.