Physiopathologie, diagnostic et prise en charge des infections génitales hautes

Pelvic inflammatory disease in the adolescent and young adult: An update

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).

[Diagnosis of pelvic inflammatory disease: Clinical, paraclinical, imaging and laparoscopy criteria. CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]

The objective of this literature review is to update the recommendations for clinical practice about the diagnosis of pelvic inflammatory disease (PID), microbiologic diagnosis excluded. An adnexal pain or cervical motion tenderness are the signs that allow a positive diagnosis of PID (LE2). Associated signs (fever, leucorrhoea, metrorrhagia) reinforce clinical diagnosis (LE2). In a woman consulting for symptoms compatible with PID, a pelvic clinical examination is recommended (grade B). In cases of suspected PID, hyperleukocytosis associated with a high C-reactive protein suggests a complicated PID or a differential diagnosis such as acute appendicitis (LE3). The absence of hyperleukocytosis or normal CRP does not rule out the diagnosis of PID (LE1). When PID is suspected, a blood test with a blood count and a CRP test is recommended (grade C). Pelvic ultrasound scan does not contribute to the positive diagnosis of uncomplicated PID because it is insensitive and unspecific (LE3). However, ultrasound scan is recommended to look for signs of complicated PID (polymorphic collection) or differential diagnosis (grade C). Waiting for an ultrasound scan to be performed should not delay the start-up of antibiotic therapy. In case of diagnostic uncertainty, an abdominal-pelvic CT scan with contrast injection is useful for differential diagnosis of urinary, digestive or gynaecological origin (LE2). Laparoscopy is not recommended for the unique purpose of the positive diagnosis of PID (grade B).

Pelvic inflammatory disease: Contemporary diagnostic and therapeutic approach

Pelvic inflammatory disease (PID) is polymicrobial infection in women characterized by inflammation of the upper genital tract, including endometritis, salpingitis, pelvic peritonitis, occasionally leading to the formation of tubo-ovarian abscess (TOA). PID primarily affects young, sexually active women, and it is highly correlated with having several sexual partners, intrauterine contraceptive device and sexually transmited diseases. The spectrum of disease is caused most commonly by Chlamydia trachomatis and Neisseria gonorrhoeae in 30-50% of cases. PID is responsible for severe acute morbidity and significant long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. The following clinical features are suggestive of a diagnosis of PID: bilateral lower abdominal tenderness, abnormal vaginal or cervical discharge, fever (higher than 38?C), abnormal vaginal bleeding, dyspareunia, cervical motion tenderness and adnexal tenderness, with or without a palpable mass. In laboratory findings, there is presence of excess leucocytes, elevated erythrocyte sedimentation rate or C-reactive protein. Transvaginal ultrasound scanning may be helpful, and its sensitivity is up to 85%. It can identify inflamed and dilated tubes and tubo-ovarian masses. Magnetic resonance imaging can be helpful in a final diagnosis in 95% of cases. In 15-30% of suspected cases, there is no laparoscopic evidence of disease. Treatment regimens for PID include broadspectrum antibiotics, including coverage for Neisseria gonorrhoeae and Chlamydia trachomatis. The usage of parenteral or oral therapy, inpatient or outpatient regimens, depends on the patient?s clinical condition. Considering the potential complications of disease, there is a need for good health educational programmes in reproductive period.