Editing Pelvic inflammatory disease (section)

== Clinical features ==

* Any sexually active female, esp those with multiple sexual partners and not using barrier protection
* Acute symptomatic
** Lower abdo pain, usually bilateral, generally 1-14 days, worsens with coitus/jarring movements, esp if starts during/after menses
** Dyspareunia
** If severe - fevers, sepsis
** Abnormal uterine bleeding in 30%
** Lower abdo signs
** Cervical motion/uterine/adnexal tenderness on pelvic exam are defining characteristics
** Purulent endocervical discharge/vaginal discharge
** Only a minority have elevation in inflammatory markers
* Perihepatitis (Fitz-Hugh Curtis Syndrome)
** Traditionally gonococcal, but now can be chlamydia
** Pathophysiology:
*** Mucopurulent exudates via Fallopian tubes
*** Scarring, adhesions, TOA
*** Infected fluid tracks up the right paracolic gutter to peri-hepatic area, where it can cause pain and adhesion formation (liver capsular stretch)
* Tubo-ovarian abscess
** Originates from local spread (bowel, adnexal surgery), haematological spread or ascending gynaecological infection
** Endothelial damage leads to tubal blockage and abscess formation