What is the differential diagnosis for this scenario?
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In the case under discussion, the patient suffers from pain in her pelvis. It is also characterized by post-coital bleeding and some thin gray vaginal discharge. No dysuria, GI symptoms, and defecation problems are reported. Regarding the current complaints of the patient, the differential diagnosis that is given is a pelvic inflammatory disease (PID). This infection bothers millions of women around the globe and includes the signs of pelvic peritonitis, tubo-ovarian abscess, and inflammation (Centers for Disease Control and Prevention, 2015). Youngkin, Davis, Schadewald, and Juve (2013) state that tubal pathologies are usually observed in about 30-40% of infertile women. This patient has three children, and the attention to such symptoms as the lower abdomen and pelvic pain, temperature, and the bleeding should be paid. Her temperature is 100.3 (it is higher than normal), she complains of pain, and her last sexual intercourse with the husband was painful and ended with bleeding.
What are the most common organisms that can cause PID?
PID has various causes and risk factors. According to the Centers for Disease Control and Prevention (2015), N. gonorrhea and C. trancomatis are the two main sexually transmitted organisms that may contribute to the development of the infection. Despite the existing public efforts to control the growth of these organisms, PID remains a problem due to its reproductive outcomes and inability to predict spontaneous ascension of microbes (Brunham, Gottlieb, & Paavonen, 2015). However, these organisms are not the only ones that may be associated with PID. M. genitalium, G. vaginalis, and anaerobes play a role in the pathogenesis of the given diagnosis (Centers for Disease Control and Prevention, 2015). Regarding such an impressive number of microorganisms that may cause PID, all patients should be tested for HIV, chlamydia, and gonorrhea as soon as they are diagnosed with PID.
What are the presenting symptoms of PID?
Taking into consideration the case of a 32-year-old mother of three children, the main presenting symptoms include pelvic pain, vaginal discharge, painful intercourses, and fever. The peculiar feature of this situation is that the woman has been suffering from all these pelvic problems during the last three weeks. She did not have a chance to visit a doctor because no one could sit with her children. On the one hand, it could be a sign that the woman took some drugs to relieve pain or has some mental or emotional changes because of the necessity to live with pain for about one month. Bleeding can be a sign of a delayed visit to a hospital and the inability to treat the infection at its initial stage (Brunham et al., 2015). To confirm the diagnosis and eliminate other problems, several tests and examinations should be performed.
What test needs to be performed to get a definitive diagnosis of PID?
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Blood and urine tests are required to check if the infection was able to reach the whole body. It is important to control an inflammation process. Diagnostic tests to assess the culture for gonorrhea and other infections are required (Centers for Disease Control and Prevention, 2015). Swab tests are usually taken as the initial stage of any examination (Brunham et al., 2015). To support a diagnosis of PID, the Centers for Disease Control and Prevention (2015) recommends paying attention to the erythrocyte sedimentation rate and the level of C-reactive proteins. Finally, the presence of white blood cells in the vaginal fluid may become evidence of the offered diagnosis. In general, the analysis of all culture tests and the laboratory documentation of the infections will be used to get a definite diagnosis.
How do you manage PID?
Management of PID can help patients deal with pain and avoid the development of other pelvic complications. Wrong management of this disease is the result of unnecessary morbidity (Centers for Disease Control and Prevention, 2015). To provide the woman with effective treatment, the results of antimicrobial tests should be used. The initial stages of treatment include the avoidance of sexual intercourses for a certain period (depending on the level of infection and the reaction of the body to medications) and the use of antibiotics to improve the vaginal culture. In some cases, the patients are offered a single dose of intramuscular ceftriaxone or cefoxitin plus probenecid followed by doxycycline during the next two weeks (Brunham et al., 2015). After the course of medications is finished, the same tests should be repeated to make sure the infection is gone, and the partner does not have this infection.
What teaching and follow-up are needed in PID?
The peculiar feature of PID in women is that its treatment should also include their partners. Even if the inflection is not detected in a man, it is necessary to treat him and prevent the possibility of re-infection. This part of education is a crucial aspect of PID patients. Even if the partner does not have any signs and symptoms of the infection, it may be present. Therefore, co-treatment is required. Follow-up is recommended in two weeks after the first visit to a doctor (Brunham et al., 2015). In case the woman has new symptoms or pain complaints, it is possible to visit a hospital earlier without any delays as it happened to the woman in this case. Finally, PID patients have to be informed about such risk factors as having multiple sex partners or having sex without a condom. Additional protection and awareness help to prevent new infections and complications.
Brunham, R. C., Gottlieb, S. L., & Paavonen, J. (2015). Pelvic inflammatory disease. New England Journal of Medicine, 372(21), 2039-2048.
Centers for Disease Control and Prevention. (2015). Pelvic inflammation disease (PID). Web.
Youngkin, E. Q., Davis, M. S., Schadewald, D., & Juve, C. (Eds.). (2013). Women’s health: A primary care clinical guide (4th ed.). New Jersey, NJ: Pearson Education.