The early symptoms of pelvic inflammatory disease are like this

Pelvic inflammatory disease is a relatively common gynecological disease in daily life. It is usually divided into acute pelvic inflammatory disease and chronic pelvic inflammatory disease. Either type can cause great harm to women's health. Therefore, it is particularly important to understand the early symptoms of pelvic inflammatory disease and treat it in time. In fact, the early symptoms of pelvic inflammatory disease include sometimes low fever and fatigue.

1. Symptoms:

1. Acute pelvic inflammatory disease

(1) Symptoms are characterized by acute onset and severe condition, including lower abdominal pain, fever, chills, headache, and loss of appetite. During the examination, the patient was found to be in an acute condition with a high temperature, a rapid heart rate, and muscle tension, tenderness, and rebound pain in the lower abdomen. Pelvic examination: There is a large amount of purulent secretions in the vagina, obvious tenderness in the vault, tenderness and rebound pain in the uterus and bilateral adnexa, or thickening of one side of the adnexa. The symptoms of chronic pelvic inflammatory disease are: slow onset and long course. Systemic symptoms are mostly not obvious, but may include low fever, fatigue, lower abdominal pain, etc. During examination, it is found that the uterus is often posterior, with limited movement, or adhesions and fixation.

(2) Acute and chronic pelvic inflammatory disease can be diagnosed based on medical history, symptoms and signs. However, differential diagnosis must be done well. The main differential diagnoses of acute pelvic inflammatory disease include acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion, etc.; the main differential diagnoses of chronic pelvic inflammatory disease include endometriosis and ovarian cancer.

2. Chronic pelvic inflammatory disease

Systemic symptoms include occasional low-grade fever and fatigue. Some patients develop symptoms of neurasthenia due to the long course of the disease, such as insomnia, lack of energy, and general discomfort. Lower abdominal distension, pain, and lumbar pain are often aggravated after fatigue, sexual intercourse, and before and after menstruation. Chronic inflammation can cause pelvic congestion and menorrhagia, menstrual disorders when ovarian function is damaged, and infertility when fallopian tube adhesions and blockages occur.

2. Physical signs:

The patient presents with acute illness, fever, increased heart rate, and muscle tension, tenderness, and rebound pain in the lower abdomen. Gynecological examination can show a large amount of purulent secretions flowing out of the cervix, obvious tenderness in the fornix, and the posterior fornix may be full and fluctuant, suggesting the presence of a pelvic abscess; the cervix is ​​congested and painful when raised; the uterine body is tender and has limited movement; both sides of the uterus are obviously tender. If it is simple salpingitis, thickening of the fallopian tubes can be felt with obvious tenderness; if it is an abscess, a tender mass with a sense of fluctuation can be felt; in case of parametrial connective tissue inflammation, flake-like enlargements can be felt on one or both sides of the parametrium, or the uterine fundus ligaments on both sides are highly edematous and thickened with obvious tenderness.

3. Diagnosis:

1. Minimum diagnostic criteria

(1) Uterine tenderness; or

(2) adnexal tenderness; or

(3) Cervical pain

The possibility of PID diagnosis is greatly increased in patients with lower abdominal tenderness accompanied by signs of lower genital tract infection.

2. Additional conditions for supporting PID diagnosis

(1) Oral temperature ≥38.3°C;

(2) mucopurulent discharge from the cervix or vagina;

(3) Microscopic examination of vaginal secretions revealed leukocytosis;

(4) Accelerated erythrocyte sedimentation rate;

(5) Increased C-reactive protein level;

(6) Laboratory examination confirms cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis.

Most patients with PID have cervical mucopurulent discharge or vaginal discharge with leukocytosis on microscopic examination. If cervical discharge appears normal and microscopic examination of vaginal discharge shows no leukocytes, the diagnosis of PID is unlikely, and other possible causes of lower abdominal pain should be considered.

If conditions permit, we should actively look for pathogenic microorganisms.

3. The most specific criteria for PID include

(1) Endometrial biopsy shows pathological histological evidence of endometritis;

(2) Transvaginal ultrasound or magnetic resonance imaging shows thickening of the fallopian tube wall and fluid accumulation in the tubal cavity, which may be accompanied by pelvic free fluid or tubal and ovarian masses;

(3) Laparoscopic examination results are consistent with PID manifestations.