#2. PID 진단, 치료, 입원 적응증

진단 - Biopsy, CRP, Fever, Leukocytosis, Gonococcus & chlamydia by nucleic acid 

Diagnosis

Traditionally, the diagnosis of PID has been based on a triad of symptoms and signs, including pelvic pain, cervical motion and adnexal tenderness, and the presence of fever. It is now recognized that there is wide variation in many symptoms and signs among women with this condition, which makes the diagnosis of acute PID difficult.

 진단에서 중요한 sign은 pelvic organ tenderness, leukorrhea and mucopurulent endocervicitis

여기서 추가적으로 특이도를 높이는 검사들이 바로 endometrial biopsy showing endometritis, CRP or ESR 상승, 38도 이상의 발열, leukocytosis, test for gonorrhea or chlamydia

 또 더 정교하게 TOA 감별 위한 TVS, Laparoscopy visually confirming salpingitis

치료 - Cefoxitin + doxycylcine// IV : clindamycin + gentamicin

Therapy regimens for PID must provide empirical, broad-spectrum coverage of likely pathogens, including N. gonorrhoeae, C. trachomatis, gram-negative facultative bacteria, anaerobes, and streptococci. Recommended regimens for the treatment of PID are listed in Table 16.5. An outpatient regimen of cefoxitin and doxycycline is as effective as an inpatient parenteral regimen of the same antimicrobials. Therefore, hospitalization is recommended only when the diagnosis is uncertain, pelvic abscess is suspected, clinical disease is severe, or compliance with an outpatient regimen is in question. Hospitalized patients can be considered for discharge when their fever has lysed (99.5'F for more than 24 hours), the white blood cell count has become normal, rebound tenderness is absent, and repeat examination shows marked amelioration of pelvic organ tenderness.

입원기준 - 진단이 불확실, 골반 농양이 의심될 경우, 임상증상이 심한 경우, 환자 치료 순응도가 낮을 경우