Pelvic Inflammatory Disease

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Step 1: View clinicals

A 21 year old nulliparous woman presents with fever for 3 days and lower abdominal pain for 1 week. She also experienced deep dyspareunia during the preceding several weeks. Her last menstrual period was 2 weeks ago. She has a single regular sexual partner. An intrauterine device was implanted for contraception around 3 months ago. Her medical and surgical histories are unremarkable. A urine pregnancy test is negative.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 13,500 (4,600 - 11,000) 85% Neutrophils Hb: 13.4 g/dL (11.5 - 18.5) Platelets: 320,000/mm3 (150,000 - 450,000)

Urinalysis

Appearance: clear Pus cells: 1 - 2 / hpf (0 - 5) RBC: nil / hpf (0 - 3) pH: 6.0 (4.5 - 8.0)

Transvaginal Ultrasound

The ultrasound scan shows bilateral thickening of the fallopian tubes and a small amount of free fluid in the pelvis. There are no tuboovarian masses or sonographic features suggestive of endometritis.

Chlamydial + Gonococcal NAAT

Positive for C. trachomatis Negative for N. gonorrhoeae


Step 3: Select appropriate management

Remove IUD
Antibiotics
Laparotomy
Danazol


Score: ★★☆