Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

Infection of Upper genital tract in females

Question 2

What organs does PID affect? (3 things)

Answer 2

1. Uterus
2. Fallopian tubes
3. Ovaries

Question 3

What age group is PID most common in?

Answer 3

15-24 yrs

Question 4

What is the general cause of PID?

Answer 4

Spread of bac infection from vagina / cervix upwards

Question 5

What are the most common organisms that cause PID? (3 things)

Answer 5

STI’s:

1. Neisseria gonorrhoea
2. Chlamydia trachomatis
3. Mycoplasm genitalium

Question 6

Which organism causes the most severe PID?

Answer 6

Neisseria gonorrhoea

Question 7

What are the RF for PID? (5 things)

Answer 7

1. Sexually active (esp without protection)
2. Recent partner change
3. Age 15-24
4. Hx of STIs / PID
5. IUD

Question 8

What are the CF of PID? (7 things)

Answer 8

1. Fever (advanced)
2. Pelvic / lower abd pain
3. Dyspareunia (pain @ intercourse)
4. Post-coital bleeding
5. Abn discharge (purulent / foul smelling)
6. Menstrual abn (menorrhagia / dysmenorrhoea)
7. Dysuria

Question 9

What are the CF of PID @ examination? (4 things)

Answer 9

1. Palpable mass
2. Pelvic / cervical tenderness
3. Inflamm cervix
4. Purulent discharge

Question 10

What are some differential Dx that present similarly to PID? (4 things)

Answer 10

1. Endometriosis
2. Ectopic pregnancy
3. Ruptured ovarian cyst
4. UTI

Question 11

What investigations should be done for sus PID? (6 things)

Answer 11

1. Endocervical (NAAT) swabs
2. Full STI screen
3. Urine dipstick / MSU
4. Pregnancy test (to exclude ectopic pregnancy)
5. Inflamm markers (CRP / ESR) (raised)
6. Transvaginal US
7. Laparoscopy

Question 12

What are you testing for in Endocervical (NAAT) swabs? (3 things)

Answer 12

1. Gonorrhoea
2. Chlamydia
3. Mycoplasm genitalium

Question 13

What are you testing for in a Full STI screen? (5 things)

Answer 13

1. HIV
2. Syphilis
3. Gonorrhoea
4. Chlamydia
5. Mycoplasm genitalium

Question 14

What is the point of a Urine dipstick / MSU in sus PID?

Answer 14

To exclude UTI’s

Question 15

When are Transvaginal US / Laparoscopy indicated in sus PID?

Answer 15

Severe cases where there is diagnostic uncertainty

Question 16

What is the point of Laparoscopy for investigating PID? (2 things)

Answer 16

1. Observe gross inflamm changes
2. Peritoneal biopsy

Question 17

What is the Tx for PID?

Answer 17

14 day broad spec abx course (w good anaerobic coverage)

Question 18

When should abx course for PID be started?

Answer 18

Immediately, even before swabs results are back

Question 19

What are the abx options for PID? (2 things)

Answer 19

1. Doxycycline + Ceftriaxone + Metronidazole
2. Ofloxacin + Metronidazole

Question 20

How should you manage pain in PID?

Answer 20

Paracetamol

Question 21

What are signs the pt has severe PID / needs further Tx? (3 things)

Answer 21

1. Sepsis signs
2. Pelvic abscess
3. Pregnant

Question 22

What further treatment is given to patients with severe PID who are admitted?

Answer 22

IV abx

Question 23

What is the Tx when a Pelvic abscess develops in PID?

Answer 23

Drainage (by interventional radiologist / surgeon)

Question 24

What are the complications of PID? (6 things)

Answer 24

1. Sepsis
2. Abscess
3. Infertility (10%)
4. Chronic pelvic pain
5. Ectopic pregnancy
6. Fitz-Hugh-Curtis syndrome

Question 25

Why is the risk of Ectopic pregnancy increased after having PID?

Answer 25

Bc narrowing + scarring of fallopian tubes

Question 26

What is Fitz-Hugh-Curtis syndrome? (2 steps)

Answer 26

1. Inf of liver capsule (aka Glisson’s capsule)
2. Leads to adhesions between Liver + peritoneum

Question 27

What are the CF of Fitz-Hugh-Curtis syndrome? (2 things)

Answer 27

1. RUQ pain
2. Referred R shoulder pain (if diaphragm irritated)

Question 28

What is used to visualise and treat adhesions of Fitz-Hugh-Curtis syndrome?

Answer 28

Laparoscopy (adhesiolysis)