Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

Result of ascending infection from the genital tract (endometritis, salpingitis, tubo-ovarian abscess)

Question 2

What is the aetiology of PID?

Answer 2

Usually STIs (Chl/Ghon). May occur after instrumentaiton of uterus. Others include anaerobes such as Mycoplasma Genitarum.

RF: STI, recent implanted IUD/IUCD, multiple sex partners, <25y, young age first sex.

Question 3

What is the epidemiology of PID?

Answer 3

1/60 GP consultations in women <45y.

Question 4

What is the Hx/ Examinations of PID?

Answer 4

Asymptomatic or presenting with infertility, chronic palvic pain. Acute: bilateral LAB pain, discharge PV, fever, irregular PVB, dyspareunia.

General: fever, malaise, tachycardia.

Abdo: LAB tenderness.

Speculum: PV discharge

Vaginal: cervical excitation, bilateral adenxal tenderness, adnexal mass (TO abscess)

Question 5

What are the Ix of PID?

Answer 5

Blood: FBC, CRP.

Micro: MSU, HVS, endocervical/chlamydia screen.

USS if TO abscess,

Other: exclude pregnancy.

Question 6

What is the management of PID?

Answer 6

Medical: analgesia, antibiotics (cephalosporin, metronidazole or doxocycine).

Consider removal of IUCD.

Surgical if abscess. Consider contact tracing if STI.

Question 7

What are the complications/ prognosis of PID?

Answer 7

Increased risk of rupture ectopic pregnancy, tubal infertility in 50%, chronic pelvic pain.

Depends on promptnes of tx. Often asymptomatic therefore high fertility related morbidity.