PID (Pelvic Inflammatory Disease)

Question 1

What is PID?

Answer 1

Infection of Female Pelvic structures. Upper genital tract - NOT Vagina and Cervix.

Question 2

What structures does PID effect?

Answer 2

Endometrium (endometritis) 
Myometerium (myometritis) 
Fallopian tubes (salpingitis) 
Ovaries (oophoritis) 
Parietal peritoneum (peritonitis)

Question 3

Pathogenesis of PID? What is an inciting event?

Answer 3

Ascending infection - STI or iatrogenic (procedures) - > cervical mucous barrier broken - > uterus - > Fallopian tubes - > Ovaries - > peritoneum.

Cervical infection with gonorrhea/chlamydia ascends when inciting event occurs and causes bacteria to arise - leading to salpingo-oophoritis

Question 4

List inciting events(PID) :

Answer 4

1. Menstrual periods - retrograde flow
2. Sex - fluids pushed into the uterus + uterine contractions - > ascent
3. Bacterial Vaginosis - bacteria break down protective cervical mucous
4. Iatrogenic events - Abortions, IUD insertion, D&C

Question 5

Causes of PID?

Answer 5

90% - STDs - Gonorrhoea, Chlamydia

10% - reproductive tract damage - from pregnancy, surgical procedures, IUD

Question 6

Which organisms cause PID?

Answer 6

1. Chlamydia - Mild form of salpingitis. Incidious onset - remains in tubes for moths/years. Slow growing in culture (2 days)
2. Gonorrhoea - rapid and intense inflammatory response. Grown rapidly in culture. Effects male partner more.

Question 7

Symptoms of PID

Answer 7

FLAP
Fever
Lower abdo tenderness 
Abnormal vaginal discharge
Pelvin pain

Question 8

Diagnosis of PID

Answer 8

FLAP symptoms present then proceed:

Cervical Gram stain or PCR
Serum hCG - rules out ectopic pregnancy
Laparoscopy

Question 9

What is Fitz - Hugh - Curtis syndrome

Answer 9

inflammation of the liver capsule + adhesion formation resulting in right upper quadrant pain