Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

PID · STI & Pelvic Inflammatory Disease

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In one line

·Bacteria from a sexually transmitted infection in the cervix climb up into the uterus, fallopian tubes, and sometimes the belly, causing infection and scarring that never fully heals.

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Normal physiology

·The cervix (neck of the womb) makes thick mucus that blocks germs from climbing up. The fallopian tubes (the tubes connecting ovaries to the uterus) have tiny sweeping hairs called cilia that push any debris back down and keep the inside sterile. Hormones—estrogen and progesterone—and your immune system adjust this barrier through the monthly cycle to stay strong.

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What goes wrong

·Bacteria—most often chlamydia (Chlamydia trachomatis) or gonorrhea (Neisseria gonorrhoeae), sometimes both or a mix of other germs—break through the cervix mucus barrier, swim up into the uterus, plant themselves in the lining, then climb into the fallopian tubes, and sometimes spill into the belly. The infection triggers swelling that kills the sweeping cilia and scars the tubes, even after the germs are gone.

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Hallmark signs

·Lower belly pain that gets worse when the doctor pushes on the cervix or ovary area during an exam (cervical motion tenderness or adnexal tenderness)
·Cervix that bleeds easily when touched (friable cervix)
·Abnormal vaginal discharge—often cloudy, yellowish, or foul-smelling
·Bleeding after sex (post-coital bleeding)
·Fever (often low-grade, sometimes higher)
·Pain during sex (dyspareunia)
·No symptoms at all in many cases—silent infection that only shows up years later as trouble getting pregnant (infertility)
·Severe lower belly pain, high fever, and feeling very sick

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Red flags · escalate now

·Severe lower belly pain with high fever and vomiting—may signal a tubo-ovarian abscess (a pus-filled pocket near the ovary) or peritonitis (infection spreading into the belly)
·Unable to walk or stand upright because of pain—suggests very swollen, inflamed pelvic organs or an abscess
·Signs of sepsis: racing heart, very low blood pressure, confusion, or extremely high or very low body temperature—bacteria may be spilling into the bloodstream

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Workup

·Nucleic acid amplification test (NAAT) for chlamydia and gonorrhea from cervical or vaginal swab
·Complete blood count (CBC) with white blood cell count and differential
·C-reactive protein (CRP) or red blood cell (erythrocyte) sedimentation rate (ESR)
·Pregnancy test (urine or serum beta-hCG)
·Pelvic ultrasound (transvaginal preferred)
·Wet mount or vaginal pH (point-of-care microscopy)

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Treatment

·Ceftriaxone 500 mg intramuscular (IM) once (updated 2020 CDC guideline dose)
·Doxycycline 100 mg by mouth twice daily for 14 days
·Metronidazole 500 mg by mouth twice daily for 14 days
·Test and treat all sexual partners from the past 60 days with the same antibiotic regimen (ceftriaxone plus doxycycline)
·Abstain from sex until both the patient and all partners complete the full antibiotic course and symptoms resolve
·Hospitalize for intravenous (IV) antibiotics (ceftriaxone or cefotetan plus doxycycline) if the patient has severe illness: high fever (≥101°F), nausea and vomiting, tubo-ovarian abscess, pregnancy, or no improvement after 72 hours of outpatient antibiotics
·Remove intrauterine device (IUD) if present and symptoms do not improve within 48–72 hours of starting antibiotics

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NCLEX trap

·PID can be silent. If a sexually active woman has cervical motion tenderness (pain when the nurse wiggles the cervix during pelvic exam) and adnexal tenderness (pain on the sides of the uterus where the tubes and ovaries sit), suspect PID and start antibiotics right away—even without fever or heavy discharge. Do not wait for the textbook picture; waiting lets the bacteria scar the tubes.
·PID needs three-drug coverage: ceftriaxone (a one-time shot to kill gonorrhea), doxycycline (twice-a-day pills for 14 days to kill chlamydia), and metronidazole (twice-a-day pills for 14 days to kill anaerobes like Bacteroides). These bacteria travel together up through the cervix and live together in the tubes. Treat all three or the infection will flare back.
·Always do a pelvic exam in any woman with lower belly pain. Cervical motion tenderness (pain when you wiggle the cervix) is the hallmark sign of PID and is absent in appendicitis. Appendicitis also does not cause adnexal tenderness (pain on both sides of the uterus). The pelvic exam separates them.
·In PID, always treat both partners for chlamydia and gonorrhea (ceftriaxone shot plus 7 days of doxycycline for the partner). Tell them no sex until both have finished all the antibiotics. The bacteria do not care who is who; they will pass back and forth.
·Admit to the hospital for IV antibiotics if: temperature over 101.5°F, pregnancy, tubo-ovarian abscess on ultrasound, inability to take pills by mouth, severe pain, or upper-belly pain with PID (perihepatitis). Inpatient IV therapy (cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin) saves the tubes and prevents abscess rupture.
·PID causes permanent scarring and damage to the cilia (tiny hairs that sweep the egg down the tube). Even a mild case can lead to infertility (blocked tubes), ectopic pregnancy (fertilized egg stuck in the scarred tube), or chronic pelvic pain (adhesions sticking organs together). This is why early diagnosis and fast treatment matter—to stop the scarring before it starts.

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