Up

A 21 year old nulliparous woman presents with fever for 3 days and lower abdominal pain for 1 week. She also experienced deep dyspareunia during the preceding several weeks.

Her last menstrual period was 2 weeks ago. She has a single regular sexual partner. An intrauterine device was implanted for contraception around 3 months ago.

Her medical and surgical histories are unremarkable. A urine pregnancy test is negative.

Select Relevant Investigations
Full Blood Count

Performed

WBC/DC: 13,500 (4,600 - 11,000)
85% Neutrophils
Hb: 13.4 g/dL (11.5 - 18.5)
Platelets: 320,000/mm3 (150,000 - 450,000)
Urinalysis

Performed

Appearance: clear
Pus cells: 1 - 2 / hpf (0 - 5)
RBC: nil / hpf (0 - 3)
pH: 6.0 (4.5 - 8.0)
Transvaginal Ultrasound

Performed

The ultrasound scan shows bilateral thickening of the fallopian tubes and a small amount of free fluid in the pelvis. There are no tuboovarian masses or sonographic features suggestive of endometritis.
Chlamydial + Gonococcal NAAT

Performed

Positive for C. trachomatis
Negative for N. gonorrhoeae

Select Relevant Management
Remove IUD
Antibiotics
Laparotomy
Danazol