What tests should be done if pelvic inflammatory disease is suspected?

Pelvic inflammatory disease is relatively common among gynecological diseases. This disease causes great harm to women. If it is not treated in time, it will cause infertility. Therefore, pelvic inflammatory disease must be detected and treated early. So if you suspect you have pelvic inflammatory disease, how do you check?

How to check if you suspect you have pelvic inflammatory disease

A basic diagnosis can be made based on medical history, symptoms, clinical symptoms and laboratory tests. Because the clinical symptoms of pelvic inflammatory disease vary greatly, the accuracy of diagnosis of the disease is not high (compared with laparoscopic surgery, the positive predictive value is 65% to 90%). Ideal diagnostic criteria for pelvic inflammatory disease should be sensitive enough to detect mild cases, yet specific enough to prevent the use of antibiotics in non-inflammatory patients. However, at this stage, there is no single medical record, clinical symptoms or laboratory test that is both sensitive and specific. Because it is difficult to accurately diagnose pelvic inflammatory disease clinically, and delayed diagnosis leads to the occurrence of complications of pelvic inflammatory disease. The diagnostic criteria for pelvic inflammatory disease (PID) recommended by the Centers for Disease Control and Prevention (CDC) in the United Kingdom in 2010 aim to improve the understanding of pelvic inflammatory disease (PID) in young women with abdominal pain or abnormal female discharge or irregular vaginal bleeding, to further evaluate suspected patients, to provide timely treatment, and to reduce the occurrence of complications. The minimum diagnostic criteria remind young women who are sexually active or are at high risk for genital tract infections that if they experience lower abdominal pain and other causes of lower abdominal pain can be ruled out, and if the gynecological examination meets the minimum diagnostic criteria, they can be given empirical antibiotic treatment. Additional criteria can improve the specificity of diagnosis. Most patients with pelvic inflammatory disease have cervical mucopurulent secretions, or a large number of white blood cells are seen in the 0.9% sodium chloride wet mount of female secretions. If the cervical secretions are normal and no white blood cells are seen under the microscope in female secretions, the diagnosis of somatic pelvic inflammatory disease should be made with caution, and other diseases that cause abdominal pain should be considered. Examination of female secretions can also detect combined vaginal infections, such as bacterial vaginitis and Trichomonas vaginitis. Specific criteria can basically diagnose pelvic inflammatory disease, but because all examinations except B-type color Doppler ultrasound are invasive or costly, specific criteria are only applicable to some selected cases. Laparoscopic diagnosis of pelvic inflammatory disease criteria include:

Blood pressure: significant hematoma on the surface of bilateral fallopian tubes;

Blood bilateral edema of the fallopian tube walls;

There is purulent exudate at the fimbria or serosa of both sides of the fallopian tubes. Laparoscopic surgery has a high accuracy in diagnosing salpingitis and can directly use secretions from the infected site for bacterial culture. However, its clinical application has certain limitations. For example, the accuracy of diagnosing mild salpingitis is low and it has no diagnostic value for independent endometritis. Therefore, not all patients suspected of pelvic inflammatory disease require laparoscopy.

What causes pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is a group of diseases caused by inflammation of the female upper reproductive system, including endometritis, salpingitis, bilateral tubal uterine and ovarian cysts and pelvic peritonitis. Most of them manifest themselves in the form of pain, accounting for more than 90%. Because pelvic organs are mostly controlled by visceral nerves, the pain sensation is often not accurately located, and the inflammation itself is not limited to a certain pelvic organ. Therefore, in clinical medicine, it is sometimes difficult to determine the exact location of the inflammation, whether it is the fallopian tubes, uterus or ovaries. Sometimes, inflammation limited to the fallopian tubes, uterus and ovaries is called adnexitis.

The main pathogens that cause pelvic inflammatory disease are: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and sexually transmitted pathogens (such as gonococci, mycoplasma positive, chlamydia, and herpes virus infection).

The main causes of acute pelvic inflammatory disease: infection after childbirth or miscarriage, infection after uterine surgery, poor hygiene during menstruation, and direct spread of inflammation of adjacent organs. Acute pelvic inflammatory disease can cause the body to produce subacute endometritis, subacute uterine myocarditis, subacute salpingitis, bilateral subcutaneous fallopian tube abscesses, bilateral fallopian tube uterus and ovarian cysts, subacute pelvic connective tissue inflammation, subacute pelvic peritonitis, sepsis and septicemia, etc.

Chronic pelvic inflammatory disease is often caused by the inability to completely cure acute pelvic inflammatory disease, or the patient's physical constitution is weak, and the current medical history changes. It can cause the body to develop chronic salpingitis and hydrosalpinx, bilateral salpingo-oophoritis and bilateral tubo-ovarian cysts, and chronic pelvic connective tissue inflammation.