PID

Question 1

How long does IUD increase risk of PID for?

Answer 1

First 4-6 weeks post fit

Question 2

Sx of PID

Answer 2

Bilat lower abdomen pain
Abnormal d/c
Deep dyspareunia
Abnormal vaginal bleeding
Secondary dysmenorrhea

Question 3

Signs of PID

Answer 3

Bilat lower abdo tender
Adnexal tenderness
Cme
Fever >38 in mod to severe

Question 4

PID complications acute

Answer 4

• Fitz- Hugh Curtis syndrome - RUQ pain with peri hepatitis. Particularly with CT. usual RX
• tubo-ovarian abscess - uss/ admit
• m

Question 5

When to remove IUD if Rx for PID not improving

Answer 5

48-72 hours

Consider PT risk and need for EC

Question 6

Long term complications of PID

Answer 6

Increase risk ectopic
Infertility
Chronic pelvic pain

Question 7

What to tell patient when diagnose with PID?

Answer 7

• Rx and side effects
• Following Rx fertility usually maintained but remains risk of future infertility, ectopic, chronic pelvic pain
• Repeat episodes increase risks of fertility
• earlier Rx better
• condoms reduce risk
• screen contacts

Question 8

1st line abx regime for PID

Answer 8

Cef 1g IM +
Doxycycline 100mg BD 14/7 +
Metronidazole 400mg BD for 14/7

Question 9

2nd line RX for PID

2 options

Answer 9

Ofloxacin 400mg BD +
Metronidazole 400mg BD for 14/7

Or

Moxifloxacin 400mg OD for 14/7

Question 10

If suspect GC PID, which abx to avoid?

Answer 10

Ofloxacin and moxifloxacin as quinolone GC resistance high

Question 11

Alternative to ofloxacin in Rx of PID due to daily dosing?

Answer 11

Levofloxacin

500mg OD for 14/7

Question 12

Main side effect of moxifloxacin

Answer 12

Serious liver reactions but these are rare

Tendon, muscle joint problems

Question 13

Risk of quinolones

Answer 13

• Moxi, ofloxacin, levofloxacin
• Can give permenant disabling side effects involving tendons, muscles, joints and the nervous system
• Only use second line except in M Gen
• Not licensed for under 18s

Question 14

3rd line alternative PID regime

Answer 14

Cef IM plus azithromycin 1g/week for 2 weeks

Ideally if M GEn neg as can cause resistance to MGen

Question 15

Inpatient PID 1st line

Answer 15

Cef 2g daily IV plus iv doxy 100mg BD + metronidazole 400mg BD oral for total 14/7

Question 16

Inpatient PID 2nd line

Answer 16

Iv clindamycin 900mg tds plus
Iv gent (2mg/kg loading) then 1.5mg/kg tds (can give OD 7mg/kg if prefer)

Followed by
Oral clindamycin 450mg qds or oral doxy 100mg bd plus
Oral metronidazole 400mg bd to complete 14/7

Question 17

Alternative IP PID regimes

Answer 17

Iv ofloxacin BD plus IV met 500mg tds for 14/7

Or

Iv ciprofloxacin 200mg BD plus
IV or oral doxy 100mg bd plus
Iv metronidazole 500mg TDS for 14/7

Question 18

Follow up schedule for PID

Answer 18

72 hour review

Further review 2-4 weeks post

Question 19

If CT positive when to do TOC?

Answer 19

3-5 weeks post if ongoing PID Sx

Question 20

If GC pos when to repeat TOC?

Answer 20

2-4 weeks post

Question 21

If M gen positive PID when repeat testing

Answer 21

Give moxi

Retest 4/52 post starting RX

Question 22

PN from PID

Answer 22

NAAT for all partners in past 6/12
If M gen test partner
Offer all doxy 100mg bd for 7/7 and no sex