Pelvic Inflammatory Disease Flashcards
(34 cards)
What is pelvic inflammatory disease (PID)?
- inflammation + infection of the organs of the pelvis
- caused by infection spreading up through the cervix
What organs can become inflamed in PID?
endometritis:
- inflammation of the endometrium
salpingitis:
- inflammation of the fallopian tubes
oophoritis:
- inflammation of the ovaries
parametritis:
- inflammation of the parametrium
peritonitis:
- inflammation of the peritoneal membrane
parametrium = connective tissue around the uterus
What are the 3 most common causes of PID?
- Neisseria gonorrhoeae produces a more severe PID
- Chlamydia trachomatis
- Mycoplasma genitalium
- as most cases of PID are caused by an STI, always treat as an STI
What are the less common causes of PID?
Gardnerella vaginalis:
- associated with bacterial vaginosis
Haemophilus influenzae:
- often associated with RTIs
Escherichia coli:
- commonly associated with UTIs
Mycobacterium tuberculosis
it is also possible to get pathogen negative PID
- this is where the swabs do not pick up the pathogen
- there is a pathogen present, it is just not picked up
What are the less common causes of PID?
Gardnerella vaginalis:
- associated with bacterial vaginosis
Haemophilus influenzae:
- often associated with RTIs
Escherichia coli:
- commonly associated with UTIs
Mycobacterium tuberculosis
it is also possible to get pathogen negative PID
- this is where the swabs do not pick up the pathogen
- there is a pathogen present, it is just not picked up
What are the RFs for PID?
- unprotected sex
- younger age
- multiple sexual partners
- existing STI
- previous PID
- presence of an IUD
(the same as for any other STI)
What are the typical symptoms associated with PID?
- fever
- dysuria
- deep dyspareunia (pain during sex)
- abnormal bleeding (IMB / PCB / menorrhagia)
- abnormal vaginal discharge (often purulent)
- pelvic / lower abdominal pain that is BILATERAL
- secondary dysmenorrhoea
pain can be unilateral
What is the difference between superficial and deep dyspareunia?
superficial:
- pain when the penis inserts into the vagina
- associated with vulval conditions / thrush
deep:
- pain is deep within the abdomen
How can the nature of the dyspareunia be used to distinguish PID from other conditions?
- there is deep dyspareunia in PID
- it is constant
- deep pelvic pain is intermittent in IBS and cyclical in endometriosis
- the pain is a menstrual type pain
ectopic pregnancy / cysts produce a similar pattern of pain
What are the 3 areas to cover in history of presenting complaint?
- pain
- bleeding
- other (incl. sexual health)
What features need to be covered in the pain HPC?
- SOCRATES to describe the pain
- presence of dysuria
- presence of DEEP dyspareunia
What features need to be covered in the bleeding HPC?
- last menstrual period (LMP) to consider chance of ectopic pregnancy
- presence of postcoital bleeding (PCB)
- presence of intermenstrual bleeding (IMB)
- recent onset menorrhagia (heavy menstrual bleeding)
- dysmenorrhoea (painful menstrual bleeding)
What other questions need to be asked in the HPC?
- change in vaginal discharge
- change in bowel habit
- presence of a fever
- sexual history - including recent change in sexual partner
- current contraception (can explain some of the bleeding)
if fever:
* consider UTI, appendicitis + severe PID
if change in BH:
* consider IBS, IBD and endometriosis
What is the onset of symptoms like in PID?
recent onset of symptoms (< 30 days)
What examinations would be performed in PID?
abdominal examination:
- including examination of inguinal LNs
bimanual examination
- also check temperature as fever can occur in moderate-severe disease
What are the typical findings on examination?
abdominal examination:
- lower abdominal / pelvic tenderness that is usually bilateral
bimanual examination:
- adnexal tenderness
- cervical motion tenderness / uterine tenderness
- may note the presence of purulent discharge
What is the first-line investigation in PID?
!! PREGNANCY TEST !!
- should be performed in ALL sexually active women with lower abdominal pain
- rules out ectopic pregnancy
What other investigations are performed in suspected PID?
- urine dipstick + MSU (if positive)
- temperature
- NAAT from a vulvovaginal swab (VVS)
- endocervical swab
- blood tests for HIV + syphilis
- consider FBC, CRP/ESR, LFTs
What is tested for on the NAAT VVS?
- NAAT swabs for gonorrhoea + chlamydia
- NAAT swabs for trichomonas if SYMPTOMATIC (itching / discharge / soreness around vulva)
- NAAT swab for Mycoplasma genitalium (if available)
NAAT = nucleic acid amplification test
Why is an endocervical swab performed?
gonorrhoea culture
- this looks at sensitivities to ensure correct antibiotics are given
If a microscope is available, what additional tests may be performed?
- microscopy for the presence of bacterial vaginosis / endocervical pus cells
- swabs taken from vagina or endocervix
- the absence of pus cells excludes PID
What are the potential complications of PID?
- tubal factor infertility
- chronic dyspareunia + pelvic pain (18%)
- Fitz Hugh Curtis syndrome
- tubo-ovarian abscess
- ectopic pregnancy
How is the risk of infertility related to PID?
- the risk of tubal factor infertility increases with number of episodes of PID
- the risk also increases if treatment is delayed
How might someone present if they have a tubo-ovarian abscess as a result of PID?
- systemically unwell
- fever
- palpable mass
- lack of response to treatment
- this is an abscess within the adnexa
- adnexa = region adjoining the uterus containing the ovary, fallopian tube + vessels, ligaments, connective tissue
