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activities involving movement. Other manifestations of PID include dysuria (difficult or painful urination) and irregular bleeding. PID often has limited or vague clinical symptoms, leading to undertreatment and long-term health effects.Because PID is a substantial health risk to a woman, the Centers for Disease Control and Prevention (CDC) encourage clinicians to consider PID as a likely diagnosis when a sexually active woman has abdominal or pelvic tenderness and one of the following: cervical motion tenderness, uterinetenderness, or adnexal tenderness.Box 24-6 lists the diagnostic criteria for PID. No labs or studies are needed to begin treatment, however, additional information can improve the specificity of diagnosis.Abdominal pain in women can have many causes, and it is important to rule out other diagnoses (Figure 24-8); however, further studies to rule out other diagnoses can be done while treating for PID.Because of the significance of the complications of PID, rapid treatment is recommended even before the causative pathogen can be identified. Because treatment is empiric, it needs to be effective against a broad range of pathogens, especially chlamydia, gonorrhea, and anaerobic bacteria.Treatment is usually
outpatient unless the woman has symptoms of advanced infection, cannot take oral medications, is pregnant, or other pathologies cannot be excluded. The CDC-recommended outpatient regimen is shown in Box 24-7.Although alternative treatment regimens are available, the growing antibiotic resistance of gonorrhea limits antibiotic choices. The CDC is closely monitoring gonorrhea’s antibiotic sensitivity and updates treatment guidelines periodically to reflect new information.The most up-to-date treatment guidelines can be found on the CDC website. Sexual partners of women with PID also should also receive treatment, even if they are asymptomatic. Women receiving treatment should be reevaluated by their care provider in 3 days to ensure antibiotic treatment is effective.Because women with a history of PID are at increased risk for ectopic pregnancy, they should seek care as soon as they know they are pregnant because ectopic pregnancy is a major cause of maternal mortality (p. 813 – 816). CONCEPT 5: QUESTIONS 66 -67; PAGE 118 - 119Polycystic ovary syndrome (PCOS) has at least two of the following conditions:oligoovulation or anovulation, elevated levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. Polycystic ovaries do not have to be present to diagnose PCOS, and conversely their presence alone does not establish the diagnosis. PCOS remains one of the most common endocrine disturbances affecting women, especially young women, and is a leading cause of infertility in the United States, where prevalence rates are estimated at between 4% and 12%, afflicting between 3.2 and 5.4 million young women.PCOS appears to be familial, and various features of the syndrome may be differentially inherited.Confusing the issue is the frequency, expression, and timing of PCOS symptoms and diagnosis. From 22% to 30% of women have