PAGE 20

developed or evaluated for

30 , 31 clinical use .

Until this is the case , the diagnosis

and treatment of PID should continue to be based on clinical features and sexual risk .

CASE STUDY

SARA , 23 , is new to the practice . She

presents with new onset pelvic pain that has worsened over the past 3-4

Graham Beards / CC BY-SA / bit . ly / 3GHUOtS

days . History reveals she broke up

with her male partner of six months

about eight weeks ago . She has since

had unprotected and protected vaginal

intercourse with a new male partner

10 and five days ago , respectively .

Sara is well , has no drug allergies , has

never been pregnant and takes no medications

. A hormonal IUD was inserted

two years ago . Since insertion of the

IUD , she has experienced occasional

light spotting ; although when asked

specifically about bleeding after sex ,

she says she noticed a small amount

of spotting the last time she had intercourse

, and deep pain she had not

experienced before . Closer questioning

reveals Sara has noticed slightly more

vaginal discharge in the past week , and

she feels more tired than usual and a

“ bit off ”. She was treated for chlamydia

about a year ago as a contact of an

infected partner and has not had any

STI testing since .

The GP considers the possible differential diagnoses for Sara ’ s pres-

Figure 9 . Gram stain of gonorrhoea .

entation ; while PID seems likely , it is

important to consider other causes ,

for a pelvic examination involving a

abdomen is soft , but tender over the

central and right sided pelvic tender-

explains that PID is the most likely

including a urinary infection , preg-

speculum and bimanual examination ;

central lower pelvis . The vulva has

ness and no palpable pelvic masses .

diagnosis based on her history and

nancy-related causes , torsion of an

she shows Sara a speculum , explains

a normal appearance . On bimanual

The GP inserts the speculum and

examination . Because she has sought

ovarian cyst and appendicitis . Sara

what will happen and why both

examination ( with gloved fingers ),

notes the vaginal walls have a nor-

medical care promptly , she can be

does not report urinary frequency

examinations are important , noting

and after locating the cervix , the

mal appearance , but the cervix looks

treated to prevent future complica-

or dysuria and had her appendix

this is the first time Sara has had such

GP warns Sara she may experience

erythematous and inflamed . The IUD

tions . The GP arranges to send the

removed as a child . She provides a

an examination . The GP advises Sara

some pain when the cervix is moved

threads are protruding about 3cm

swabs and urine sample to the labo-

mid-stream urine sample that on uri-

that she can stop the examination at

from side to side ( known as cervical

through the cervical os . The GP takes

ratory . However , while it is important

nalysis is negative for nitrites but has

any time if it is too uncomfortable ,

motion tenderness ) as this action will

endocervical swabs for C . trachoma-

to check for infections such as chla-

2 + leucocytes . A urinary pregnancy

asks her to undress behind the cur-

help determine a diagnosis of PID .

tis , N . gonorrhoea and M . genitalium ,

mydia or gonorrhoea , in most cases of

test is negative . She is afebrile and

tain and position herself on the bed

Sara confirms cervical movement is

and a high vaginal swab for micros-

PID no specific organism is identified ,

normotensive .

using the modesty cover .

quite painful , like the pain she expe-

copy , culture and sensitivities .

and it is important to start treatment

The GP obtains consent from Sara

Initial examination finds the

rienced with intercourse . There is

After Sara has dressed , the GP

straight away .