Sexually Transmitted Diseases - Pelvic Inflammatory Disease (PID)

Question 1

What is Pelvic Inflammatory Disease? (3)

Answer 1

1. Infection and Inflammation of Organs of Pelvis - Ascending Infection through Cervix.
2. Cause of Tubular Infertility and Chronic Pelvic Pain.
3. Manifestations : Endoemtritis; Salpingitis; Oophoritis; Parametritis; Peritonitis.

Question 2

Aetiology of PID (2).

Answer 2

1. Most STIs e.g. Gonorrhoea (Severe); Chlamydia; Mycoplasma genitalium
2. Non-STIs e.g. G. Vaginalis (BV); H. influenzae; E. coli (UTIs).

Question 3

Clinical Presentation of PID (6).

Answer 3

1. Pelvic/Lower Abdominal Pain.
2. Abnormal Vaginal Discharge.
3. Abnormal Bleeding.
4. Dyspareunia.
5. Fever.
6. Dysuria.

Question 4

Examination Findings of PID (4).

Answer 4

1. Pelvic Tenderness.
2. Cervical Excitation / Cervical Motion Tenderness.
3. Cervicitis.
4. Purulent Discharge.

Question 5

Investigations of PID (3).

Answer 5

1. Find the underlying cause :
   A. NAAT Swabs : Gonorrhoea, Chlamydia, M. genitalium.
   B. HIV Test, Syphilis Test.
   C. High Vaginal Swab : BV, Candidiasis, Trichomoniasis.
2. Microscope : Pus Cells on Swabs from Vagina/Endocervix.
3. Pregnancy Test : Ectopic Pregnancy.

Question 6

Management of PID (5).

Answer 6

1. Single Dose of IM Ceftriaxone 1g (Gonorrhoea).
2. Doxycycline 100mg BD for 14 days (Chalmydia, M. genitalium).
3. Metronidazole 400mg BD for 14 Days (Anaerobes e.g. G. vaginalis).
4. Admission if Septic, Pregnant - IV Antibiotics.
5. Drainage of Pelvic Abscess (IR/Surgery).

Question 7

What is Fitz-Hugh-Curtis Syndrome? (6)

Answer 7

1. Complication of PID.
2. Inflammation and Infection of Glisson’s Capsule (Liver Capsule).
3. Adhesion between Liver and Peritoneum : bacterial spread from pelvis via peritoneal cavity, lymphatics, blood.
4. RUQ Pain (referred to right shoulder pain).
5. Investigation : Laparoscopy.
6. Management : Adhesiolysis.