A 24 year old female presents to the family practice clinic with lower abdominal pain, nausea, vomiting, and urinary discomfort. She reports white, purulent discharge. Physical exam reveals tenderness with cervical motion and adnexal tenderness. She is sexually active and reports irregular bleeding and uses an IUD.
Labs: intracellular gram negative diplococci in the PMNs. Organism is isolated on Thayer-Martin media. Aerobic, oxidase positive.
Discussion: PID is a clinical syndrome caused by the ascent of microorganisms from the vagina and endocervix to the endometrium, fallopian tubes, ovaries, and contiguous structures. PID is a broad term that includes a variety of upper genital tract infections, unrelated to pregnancy or surgical procedures, such as salpingitis, salpingo-oophoritis, endometritis, tubo-ovarian inflammatory masses, and pelvic or diffuse peritonitis. It is difficult to determine the cause of the PID by clinical presentation. It is the lab in this instance that differentiates Neisseria gonorrhoeae from Chlamydia trachomatis. Neisseria gonorrhoeae is a sexually transmitted disease. With Neisseria gonorrhoeae, a presumptive infection of Chlamydia trachomatis must be treated. The precise mechanism by which microorganisms ascend from the lower genital tract is not known. Factors that predispose to the ascent of bacteria include the use of an intrauterine device (IUD) and the hormonal and physical changes associated with menstruation.
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