Consider the following diagnostic criteria for acute pelvic inflammatory disease (PID): 1. Lower abdominal tenderness 2. Oral temperature >38 °C 3. Adnexal tenderness 4. Cervical motion tenderness Which of the above are included in the minimum criteria for diagnosis of PID?
1, 3 and 4
The correct answer is 1, 3 and 4. The CDC minimum criteria for empirically treating acute pelvic inflammatory disease in a sexually active young woman with pelvic pain, once other causes are excluded, are lower abdominal (uterine) tenderness, adnexal tenderness and cervical motion tenderness (Chandelier sign). The threshold is deliberately low because PID is often subclinical yet causes tubal infertility, ectopic pregnancy and chronic pelvic pain; any one of these three justifies starting antibiotics.
Statement 2, oral temperature above 38 degrees C, is not a minimum criterion — it is an additional (supportive) criterion, along with mucopurulent cervical discharge, abundant white cells on saline microscopy, raised ESR or CRP, and documented Neisseria gonorrhoeae or Chlamydia trachomatis. Most PID patients are afebrile, so requiring fever would miss many cases; every option containing 2 is therefore wrong. The definitive criteria are different again: endometrial biopsy showing endometritis, imaging showing thickened fluid-filled tubes, and laparoscopic confirmation.
Key point: The minimum criteria are the three tendernesses — uterine, adnexal and cervical motion. Fever and raised CRP are only supportive; laparoscopy and endometrial biopsy are definitive.
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Important Questions from Infections in Genital Tract
Which of the following are characteristics of Trichomonas vaginitis?
1. Presence of greenish frothy discharge
2. Vaginal pH > 4.5
3. Presence of clue cells in microscopic examination
4. Strawberry spots on the vaginal mucosa
Select the correct answer using the code given below:- Monilial vaginitis is commonly associated with all EXCEPT:
- A 30 year old lady, P2L2 presents with painful unilateral swelling in vulva for 3 days. Which
of the following statements are true regarding the above case?
1. Bartholin's abscess may be the likely diagnosis
2. It is to be managed by marsupialisation
3. Gonococcus is the most common pathogenic organism
Select the correct answer using the code given below: - Which of the following is NOT a characteristic clinical feature of Bacterial Vaginosis?
A 22 year old woman comes with complaints of pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium minus, overlying skin is red and edematous. What is the most probable diagnosis?
