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Medical Disability Advisor  >  Pelvic Inflammatory Disease

Pelvic Inflammatory Disease

Related Terms

  • PID
  • Salpingitis
  • Salpingo-oophoritis
  • Tubal Infection

Differential Diagnoses

  • Appendicitis
  • Diverticulitis
  • Ectopic pregnancy
  • Endometriosis
  • Ovarian cysts
  • Ulcerative colitis

Specialists

  • Gynecologist
  • Infectious Disease Internist
  • Obstetrician / Gynecologist
  • Pediatrician

Comorbid Conditions

  • Other Sexually Transmitted Diseases

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Factors Influencing Duration

Factors that might influence the length of disability include severity of the infection, job demands, and whether surgery was performed. Laparoscopic surgery will usually have a shorter disability than surgery to remove the uterus, ovaries, and/or fallopian tube(s).

Duration Trends from Reference Data

DURATION TRENDS
 ICD-9-CM: 614.3, 614.6, 614.9  
CasesMeanMinMaxNo Lost TimeOver 6 Months
7253701370.1%0%
 
  
 
Percentile:5th25thMedian75th95th
Days:818354778
 
  
 

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

ICD-9-CM:
614.3 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Pelvic Cellulitis and Parametritis, Acute; Abscess (of): Broad Ligament Acute or NOS; Parametrium Acute or NOS; Pelvis, Female Acute or NOS; Pouch of Douglas Acute or NOS
614.4 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Pelvic Cellulitis and Parametritis, Chronic or Unspecified; Abscess (of): Broad Ligament Chronic or NOS; Parametrium Chronic or NOS; Pelvis, Female Chronic or NOS; Pouch of Douglas Chronic or NOS
614.5 - Pelvic Peritonitis, Acute or Unspecified, Female
614.6 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Pelvic Peritoneal Adhesions, Female (Postoperative) (Postinfection)
614.7 - Inflammatory Disease of Ovary, Fallopian Tube, Pelvic Cellular Tissue, and Peritoneum, Pelvic Peritonitis, Chronic, Female
614.9 - Pelvic Inflammatory Disease (PID), Unspecified; Pelvic Infection or Inflammation, Female

Definition

© Reed Group
Pelvic inflammatory disease (PID) is an infection of the upper female genital tract caused by bacteria.

The disease can manifest as any combination of infection of the ovaries, fallopian tubes, or uterus (oophoritis, salpingitis, and endometritis, respectively); tubo-ovarian abscess; and pelvic peritonitis.

Pelvic inflammatory disease is a common problem that may be a sexually transmitted disease (STD). Most often it is caused by sexually transmitted infections of Chlamydia trachomatis, Neisseria gonorrhoeae, or both, although it may be caused by bacteria that are normally found in the vagina. The infection can spread throughout the fallopian tubes and cause inflammation, scarring, and obstruction.

Risk: Risk factors for PID include having multiple sexual partners, having sexual intercourse at a young age, using an IUD, and smoking cigarettes.

Women who have multiple sexual partners and who use an intrauterine device (IUD) for birth control have a higher rate of PID. Monogamous women using an IUD have no increased incidence of PID.

Incidence and Prevalence: Approximately 11% of women in the US will develop PID during their reproductive years, and a significant number will have complications from the infection (Hill).

Source: Medical Disability Advisor



History

History: The individual may report fever, foul-smelling vaginal discharge, pain in the lower abdomen, pain with sexual intercourse (dyspareunia), abnormal uterine bleeding, and tenderness or pain in the uterus, affected ovary, or fallopian tube. Some cases occur without symptoms (asymptomatic). whereas others have mild or nonspecific symptoms. Severe PID is usually very painful.

Physical exam: The uterus, ovary, or fallopian tube can be enlarged or tender on bimanual pelvic examination. An oral temperature of greater than 101° F (38.3° C) is indicative of infection, along with the other signs of lower abdominal tenderness and abnormal vaginal discharge.

Tests: Swabs from the vagina and cervix are cultured to identify the infecting microorganism. A complete blood count (CBC) may be done to detect an elevated white blood cell count in the presence of infection. A microscopic examination of the tissues (histologic exam) from endometrial biopsy may be performed to test for evidence of endometritis. Laparoscopic examination may also reveal abnormalities consistent with PID.

Source: Medical Disability Advisor



Treatment

Treatment with oral antibiotics that are effective against a broad range of microorganisms, including Neisseria Gonorrhoeae and Chlamydia trachomatis, should be started immediately. Follow-up care should be available within 72 hours to evaluate response to treatment.

Hospitalization of individuals with PID is recommended in a few instances, such as pregnancy, surgical emergencies that cannot be excluded (appendicitis), severe illness with high fever or nausea and/or vomiting, the presence of a tubo-ovarian abscess, and a weakened immune system. Individuals who cannot follow or tolerate the oral antibiotic regimen and those who show no clinical response to oral antimicrobial therapy may need to be hospitalized as well. Besides antibiotic therapy, bed rest and surgical drainage of an abscess may be required.

In severe cases of PID, surgical removal of the uterus (hysterectomy) may be necessary to prevent fatal blood infection (septicemia). If gonococci or chlamydiae have caused the infection, the woman's sexual partners should also treated with antibiotics. An IUD, if present, should usually be removed.

Source: Medical Disability Advisor



Prognosis

A favorable outcome depends on prompt diagnosis and treatment with broad-spectrum antibiotics. With chronic, recurring PID, each episode increases the chance of infertility; tubal scarring and obstruction leading to tubal pregnancy; and abscesses of the ovaries, fallopian tubes, and other pelvic areas.

Source: Medical Disability Advisor



Complications

Complications of PID include infertility, scarring or obstruction of the fallopian tubes, chronic pelvic pain, tubal pregnancy, and spontaneous abortion. In approximately 20% of women who have had PID, infertility occurs ("Pelvic Inflammatory Disease"). A woman with PID has a much higher risk of a tubal pregnancy because the fertilized egg cannot pass through the blocked fallopian tubes. Untreated PID results in chronic pelvic pain in many individuals.

Source: Medical Disability Advisor



Return to Work (Restrictions / Accommodations)

Work restrictions may need to be applied for a limited time in severe cases and when surgery (hysterectomy) is performed.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is the woman sexually active?
  • Does she use an IUD for contraception?
  • Did individual present with symptoms and clinical findings consistent with the diagnosis of PID?
  • Was an endometrial culture done?
  • If the clinical evidence was inconclusive, were appropriate additional diagnostic tests done to confirm the diagnosis (ESR, C-reactive protein, endometrial biopsy, ultrasound or laparoscope)?
  • If diagnosis was uncertain, were other conditions with similar symptoms ruled out?
  • Was a pregnancy test done?

Regarding treatment:

  • Was individual treated promptly with broad-spectrum oral antibiotics?
  • Was individual reexamined within 72 hours to determine response to treatment?
  • Was hospitalization indicated?
  • Was surgical intervention indicated?
  • Was IUD removed?

Regarding prognosis:

  • Did the woman receive prompt and appropriate treatment?
  • Did the woman experience any complications that may influence prognosis and length of disability?
  • Did the woman have any comorbid conditions that may have affected her ability to recover?
  • Were these conditions addressed appropriately in the treatment plan?
  • Is PID a chronic problem for the woman?

Source: Medical Disability Advisor



Cited References

Hill, James B., and Ernest Lockrow. "Pelvic Inflammatory Disease." eMedicine. Eds. Ronald Levine, et al. 5 Oct. 2004. Medscape. 6 Oct. 2004 <http://emedicine.com/med/topic1774.htm>.

"Pelvic Inflammatory Disease." National Institute of Allergy and Infectious Diseases. Jul. 1998. National Institutes of Health (NIH). 6 Oct. 2004 <http://www.niaid.nih.gov/factsheets/stdpid.htm>.

Source: Medical Disability Advisor






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