For sexually active women with symptom of lower abdominal pain, WHO suggests assessing for pelvic inflammatory disease and treating syndromically. (Conditional recommendation; low-certainty evidence)
Good practice includes:
  • taking a medical and sexual history and assessing the risk of STIs;
  • performing a physical examination, including abdominal and pelvic examination, to assess for pelvic inflammatory disease, surgical conditions or pregnancy and vulvovaginal examination to visualize any lesions, overt genital discharge, vulval erythema and excoriations;
  • performing a bimanual digital examination of the vagina (1) to assess for cervical motion tenderness or pain with palpation of the pelvic area to exclude pelvic inflammatory disease; and (2) to assess for the presence of vaginal discharge and the colour and consistency of the discharge on the glove; and
  • offering HIV and syphilis testing and other preventive services as recommended in other guidelines.
Good practice statement
For sexually active women with lower abdominal pain with either of the following features on clinical examination (bimanual palpation):
  • cervical motion tenderness; or
  • lower abdominal tenderness:
WHO suggests the following.
  • Treat for pelvic inflammatory disease on the same visit.
  • Test for infection with N. gonorrhoeae and C. trachomatis and, if available, M. genitalium, to support partner management when tests are available.
  • Schedule follow-up assessment three days later to assess for clinical improvement, and if the woman has not improved, refer for further assessment.
(Conditional recommendation; moderate-certainty evidence)
For women with lower abdominal pain with any of the following conditions, good practice includes referral to surgical or gynaecological assessment:
  • missed or overdue period;
  • recent delivery, abortion or miscarriage;
  • abdominal guarding and/or rebound tenderness;
  • abnormal vaginal bleeding in excess of spotting;
  • abdominal mass; and
  • detection of a suspected cervical lesion.
Good practice statement

From: 9, LOWER ABDOMINAL PAIN

Cover of Guidelines for the management of symptomatic sexually transmitted infections
Guidelines for the management of symptomatic sexually transmitted infections [Internet].
Geneva: World Health Organization; 2021 Jun.
© World Health Organization 2021.

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