Pelvic inflammatory disease is most strongly suggested by which combination?

Pelvic inflammatory disease is most strongly suggested by which combination?

• A. Bacterial vaginosis with abdominal pain
• B. Ectopic pregnancy with amenorrhea
• C. Sexually transmitted disease features with mucopurulent discharge and cervical motion tenderness, often with fever
• D. Uterine fibroids with heavy menses

Answer: (C)

Pelvic inflammatory disease is suggested when there is evidence of an ascending infection from the cervix to the upper genital tract, leading to cervicitis plus involvement of the uterus and/or adnexa. The combination described—mucopurulent discharge indicating cervicitis, cervical motion tenderness signaling inflammation of the uterus or tubes, and fever reflecting systemic infection—best fits PID. This pattern points to an infectious process spreading upward, rather than a purely localized or noninfectious condition. Other options either reflect noninfectious processes or different clinical scenarios. Bacterial vaginosis can cause discharge but typically lacks the pelvic tenderness and fever that accompany upper genital tract infection. Ectopic pregnancy with amenorrhea highlights pregnancy-related signs rather than mucopurulent cervicitis and cervical motion tenderness with fever. Uterine fibroids with heavy menses are structural and not infectious, so they wouldn’t produce mucopurulent discharge or fever. In practice, recognizing this combination prompts prompt evaluation and empiric treatment to prevent complications like infertility or chronic pelvic pain, while also ruling out pregnancy and testing for sexually transmitted infections.

Pelvic inflammatory disease is suggested when there is evidence of an ascending infection from the cervix to the upper genital tract, leading to cervicitis plus involvement of the uterus and/or adnexa. The combination described—mucopurulent discharge indicating cervicitis, cervical motion tenderness signaling inflammation of the uterus or tubes, and fever reflecting systemic infection—best fits PID. This pattern points to an infectious process spreading upward, rather than a purely localized or noninfectious condition.

Other options either reflect noninfectious processes or different clinical scenarios. Bacterial vaginosis can cause discharge but typically lacks the pelvic tenderness and fever that accompany upper genital tract infection. Ectopic pregnancy with amenorrhea highlights pregnancy-related signs rather than mucopurulent cervicitis and cervical motion tenderness with fever. Uterine fibroids with heavy menses are structural and not infectious, so they wouldn’t produce mucopurulent discharge or fever.

In practice, recognizing this combination prompts prompt evaluation and empiric treatment to prevent complications like infertility or chronic pelvic pain, while also ruling out pregnancy and testing for sexually transmitted infections.