Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration.
LMP 2 weeks ago (regular) Reports oral contraceptive use Reports pain in lower abdomen with cramping and pain on urination for 3 days Denies any GI problems, reports regular bowel movements.
Denies vaginal discharge Ann is married and in a monogamous relationship. Has one child age 2 Reports no use of condoms/sexual intercourse 2-3 times per week Denies any history of STDs
Physical Exam reveals:
Temp 100. 6, P 80 BP 100/62 Wt. 125 Ht. 5’3’’ HEENT WNL No CVA tenderness Pain in lower quadrants with light palpation. Positive inguinal lymphadenopathy External genitalia without lesions or discharge Pelvic exam reveals minimal cervical mucopus Bimanual exam reveals uterine and adnexal tenderness and cervical motion pain. Uterus anterior, midline, smooth, not enlarged
1. Based on the above case the diagnosis is PID, What is an appropriate CDC-recommended therapeutic regimen for this patient?
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.
Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders of the upper female genital tract (CDC, 2015). The diagnosis of PID should be made clinically in the absence of other obvious causes in an at-risk woman with unexplained pelvic pain and cervical motion, uterine, or adnexal tenderness (Curry et al, 2019). In this example, the patient’s bimanual exam meets CDC criteria for a likely PID diagnosis. No laboratory tests are needed to begin treatment (Huether et al, 2020). Although Ann is married and states she is in a monogamous relationship, one must consider one partner has had other sexual partners. Many women falsely believe they are in a monogamous relationship or that their partner does not harbor an STI; therefore, a low threshold for screening is warranted (Cuerry et al, 2019). Sexually transmitted organisms, especially N. gonorrhoeae and C. trachomatis, are implicated in many cases (CDC, 2015). Both Ann and her husband should be tested for gonorrhea and chlamydia.Recommended Intramuscular/Oral Regimens per CDC Guidelines:The patient should be re-evaluated in 3 days to ensure antibiotic treatment is effective. Partners should also be treated to prevent recurrence. Curry, A., Williams, T., & Penny, M. L. (2019). Pelvic inflammatory disease: Diagnosis,Heuther, S., McCance, K., and Brashers, V. (2020). Understandingless1 UnreadUnread3 ViewsViews
View profile card for Steven Bartos
Last post March 13 at 12:17 PM by Steven Bartos
Pathophysiology (7th ed). Elsevier.
management, and prevention. American Family Physician, 100(6), 357-364.
Centers for Disease Control – 2015 Sexually Transmitted Diseases Treatment Guidelines
Ceftriaxone 250 mg IM in a single dose PLUS
Doxycycline 100 mg orally twice a day for 14 days WITH* or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
Presumptive treatment should be initiated based on the significant complications of PID. Intramuscular/oral therapy can be considered for women with mild-to-moderately severe acute PID.
Pelvic inflammatory disease is a condition and disorder that affects the female reproductive organs. This condition primarily occurs when sexually transmitted bacteria move from the vagina to other parts of the reproductive systems, including the uterus, fallopian tubes, and ovaries (Llata et al., 2015). PID is associated with morbidity and mortality among women and is also associated with infertility, pelvic pain, and ectopic pregnancy. Some of the significant signs and symptoms of this condition include pain during intercourse, generalized pain, abnormal virginal discharge, fever, and painful and frequent urination (Huether et al. 2020). It should be noted that the bacteria that cause this infection is acquired during unprotected sex. The CDC recommends that sexually active young women should be put under empiric treatment of PID if they show the above symptoms.ReferencesHuether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosby. less1 UnreadUnread3 ViewsViews
View profile card for Sheryl Dixon
Last post March 13 at 12:14 AM by Sheryl Dixon
Llata, E., Bernstein, K. T., Kerani, R. P., Pathela, P., Schwebke, J. R., Schumacher, C., … & Weinstock, H. S. (2015). Management of Pelvic Inflammatory Disease in Selected US Sexually Transmitted Disease Clinics: Sexually Transmitted Disease Surveillance Network, January 2010–December 2011. Sexually transmitted diseases, 42(8), 429. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6740322/
According to CDC (2020), PID can be treated using different types of antibiotics such as Metronidazole. These drugs are broad spectrum and cover all the likely pathogens to causes the condition. Sexually transmitted organisms, especially Neisseria gonorrhoea and Chlamydia trachomatis have been implicated in many cases; however microorganisms that comprise the vagina flora such as anaerobes, Gardnerella vaginalis, Haemophilus influenzae, entetric Gram-negative rods and Streptococccus agalactiae also have been associated with PID. However, it should be noted that antibiotic treatment does not reverse the already-caused scarring. Therefore, it is advised that women should seek care immediately if they experience symptoms, especially pelvic pains. Prompt antibiotic treatment can reduce adverse effects of the condition, such as organ damage to the reproductive system. The provider should advise the patients to finish taking all the prescribed medications. Moreover, the women’s sexual partners should be treated even if they show no symptoms to avoid any chances of reinfection. Individuals can avoid contracting this condition by avoiding unsafe sexual practices and adopting temporary abstinence, especially during treatment.
Pelvic inflammatory disease (PID) is caused by an underlying infection of the reproductive organs of the upper genital tract. It is a sexually transmitted infection that can go undiagnosed for some time before a show of symptoms. Ann presents with many symptoms that meet the diagnostic criteria for pelvic inflammatory disease. These consist of pain in the lower abdomen with cramping, dysuria, cervical motion pain, cervical mucopus, adnexal tenderness and cervical motion pain (Huether et. al., 2020). The main pathogens are usually Neisseria gonorrhoeae and chlamydia trachomatis but can be caused by other organisms. The CDC recommends a broad-spectrum coverage that includes parenteral and oral regimens (CDC, 2015). A study by Risser et. al. reveals treatment recommendations for outpatient therapy, “one dose of parenteral cephalosporin, followed by 2 weeks of oral doxycycline, with or without 2 weeks of metronidazole” (2017, p. 9). It is also important to remind women to abstain from sex until medication is completed, and symptoms are resolved (CDC, 2015). Partners should also be treated to prevent reinfection.Centers for Disease Control and Prevention. (2015). Pelvic Inflammatory Disease (PID). Retrieved from https://www.cdc.gov/std/tg2015/pid.htmRisser, W. L., Risser, J. M., & Risser, A. L. (2017). Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents. Adolescent health, medicine and therapeutics, 8, 87–94. https://doi.org/10.2147/AHMT.S115535less2 UnreadUnread4 ViewsViews
View profile card for Dennies Jones
Last post March 12 at 11:33 PM by Dennies Jones
Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.). Elsevier.
Module 8Symptoms of PID are generally nonspecific and it is important to rule out pregnancy before making a diagnosis (Cueva et al., 2020). The most frequent manifestations of PID include vaginal discharge, pelvic discomfort, lower abdominal tenderness, fever, and cervical motion tenderness (Cueva et al., 2020). If left untreated, long term effects of inflammation can cause changes in the epithelial cells of the lining of the upper reproductive tract, causing necrosis or obstruction (Huether et al., 2020). Scarring an also occur which can increase the risk for ectopic pregnancy later on (Huether et al., 2020). Cueva, F., Caicedo, A., & Hidalgo, P. (2020). A need for standardization of the diagnosis and treatment of pelvic inflammatory disease: Pilot study in an outpatient clinic in quito, ecuador. Infectious Diseases in Obstetrics and Gynecology, 2020, 1–6. https://doi.org/10.1155/2020/5423080Vanthuyne, A., & Pittrof, R. (2016). Diagnosis and treatment of pelvic inflammatory disease. Prescriber, 27(10), 47–50. https://doi.org/10.1002/psb.1507 less1 UnreadUnread4 ViewsViews
View profile card for Candice Russell
Last post March 12 at 5:20 PM by Candice Russell
Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.
Treatment of pelvic inflammatory disease starts with prevention. Education should be provided to high-risk patients regarding safe sex practices. Also, patients should have access to pregnancy and STI testing (Vanthuyne & Pittrof, 2016). The goal of treatment in PID is to reduce inflammation and prevent long term effects (Cueva et al., 2020). Treatment often includes antibiotics and can usually be managed on an outpatient basis (Huether et al., 2020). The antibiotics prescribed are generally broad spectrum to isolate aerobic and anerobic bacteria in the genital tract (Vanthuyne & Pittrof, 2016). The most common antibiotic regimen is doxycycline with or without a combination of a cephalosporin or ceftriaxone (Huether et al., 2020). Metronidazole is often given in conjunction to provide coverage for anaerobic organisms and to assist with treatment of bacterial vaginosis which commonly occurs alongside PID (Vanthuyne & Pittrof, 2016). Antibiotics will be given twice a day for 2 weeks and it is important a follow up appointment is made within 5 days of treatment initiation to check for progress (Cueva et al., 2020).
Pelvic inflammatory disease (PID) is an inflammatory process caused by an infection in sexually active females of reproductive age (Vanthuyne & Pittrof, 2016). PID results from the movement of micro-organisms from the lower to the upper genital tract (Vanthuyne & Pittrof, 2016). The most common causes of PID are sexually transmitted diseases, specifically gonorrhea and chlamydia (Huether et al., 2020). Anaerobic organisms can cause PID due to their ability to disrupt the pH level in the vagina, causing less protective mucus development which usually protects the cervix under normal conditions (Huether et al., 2020). Risk factors for PID include having multiple sexual partners, young age (<25 years), history of STIs, and a prior history of PID (Vanthuyne & Pittrof, 2016).
Pelvic inflammatory disease (PID) is caused due to inflammation of the upper genital tract from an infection (Jennings & Krywko, 2020). This disorder affects women that are 15 to 25 years of age. It can spread to the uterus, fallopian tubes or ovaries, and cause infertility and ectopic pregnancy. Signs and symptoms of PID include lower abdominal or pelvic pain, dyspareunia, vaginal discharge, and vaginal bleeding. PID is caused by sexually transmitted bacteria. The most common bacteria are N. gonorrhoeae and C. trachomatis (Jennings & Krywko, 2020). Centers for Disease Control and Prevention. (2015, June 4). Pelvic Inflammatory Disease (PID). U.S. Department of Health and Human Services. https://www.cdc.gov/std/tg2015/pid.htmJennings, K. L., & Krywko, M. D. (2020, November 20). Pelvic Inflammatory Disease. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499959/