Pelvic inflammatory disease

Question 1

What is pelvic inflammatory disease (PID)?

Answer 1

inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix. It is a significant cause of tubular infertility and chronic pelvic pain.

Question 2

What is endometritis?

Answer 2

Inflammation of endometrium

Question 3

Difference between endometritis and endometriosis?

Answer 3

Endometriosis is when pieces of your uterine lining develop in places other than the uterus, like your ovaries or fallopian tubes.

Endometritis is inflammation of the lining of the uterus.

Question 4

What is salpingitis?

Answer 4

Inflammation of fallopian tubes

Question 5

What is oophoritis?

Answer 5

Inflammation of ovaries

Question 6

What is parametritis?

Answer 6

Inflammation of the paremetrium (connective tissue around the uterus).

Question 7

What is peritonitis?

Answer 7

Inflammation of the peritoneal membrane.

Question 8

Common sexually transmitted causes of PID?

Answer 8

Neisseria gonorrhoeae tends to produce more severe PID

Chlamydia trachomatis

Mycoplasma genitalium

Question 9

Common non-sexually transmitted causes of PID?

Answer 9

Gardnerella vaginalis (associated with bacterial vaginosis)

Haemophilus influenzae (a bacteria often associated with respiratory infections)

Escherichia coli (an enteric bacteria commonly associated with urinary tract infections)

Question 10

Risk factors for PID?

Answer 10

Not using barrier contraception
Multiple sexual partners
Younger age
Existing sexually transmitted infections
Previous pelvic inflammatory disease
Intrauterine device (e.g. copper coil)

Question 11

How can IUD’s cause PID?

Answer 11

IUD insertion introduces temporary microbial contamination into the uterus, thereby bringing about a 6-fold increased risk of PID during the first 20 days after insertion.

Question 12

Investigations for PID?

Answer 12

To swab for causative organisms and other potentially sexually transmitted disease

Question 13

NAAT swabs can be done for what conditions and pathogens?

Answer 13

Chlamydia, gonorrhoea and mycoplasma genitalium

Question 14

What is a high vaginal swab?

Answer 14

medical procedure performed in obstetrics and gynaecology to test vaginal discharge for the presence of vaginal thrush, bacterial vaginosis and trichomonas vaginalis.

Question 15

What is bacterial vaginosis?

Answer 15

Bacterial vaginosis (BV) refers to an overgrowth of bacteria in the vagina, specifically anaerobic bacteria.

It is not a sexually transmitted infection. It is caused by a loss of the lactobacilli “friendly bacteria” in the vagina.

Question 16

Bacterial vaginosis does not affect risk of developing STI’s. True/false?

Answer 16

False

Bacterial vaginosis can increase the risk of women developing sexually transmitted infections.

Question 17

What is lactobacilli?

Answer 17

main component of the healthy vaginal bacterial flora.

These bacteria produce lactic acid that keeps the vaginal pH low (under 4.5). The acidic environment prevents other bacteria from overgrowing.

Question 18

What happens when there is reduced lactobacilli in the vagina?

Answer 18

pH rises.

This more alkaline environment enables anaerobic bacteria to multiply.

Question 19

Examples of anaerobic bacteria causing bacterial vaginosis?

Answer 19

Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species

Question 20

Risk factors that increase chance of developing bacterial vaginosis?

Answer 20

Multiple sexual partners (although it is not sexually transmitted)

Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)

Recent antibiotics

Smoking

Copper coil

Question 21

Major feature of bacterial vaginosis?

Answer 21

Foul-smelling (fishy) discharge with watery white or grey vaginal dischage.

Although in around half of cases, patients are asymptomatic

Question 22

Itching, irritation and pain are typically associated with BV. true/false?

Answer 22

False

Not usually associated and suggests an alternative cause or co-occurring infection.

Question 23

What pH value does BV usually occur with?

Answer 23

Above pH of 4.5

Question 24

What types of cells are present with BV on microscopy?

Answer 24

“Clue cells”

These are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.

“Clue cells” on microscopy = BV (bacterial vaginosis)

Question 25

If bacterial vaginosis is asymptomatic, it doesn’t require treatment and may resolve on it’s own. True/false?

Answer 25

True

Question 26

What antibiotics may be used in cases where there is symptomatic BV?

Answer 26

Metronidazole is the antibiotic of choice for treating bacterial vaginosis. Metronidazole specifically targets anaerobic bacteria.

This is given orally, or by vaginal gel. Clindamycin is an alternative but less optimal antibiotic choice.

Question 27

What can bacterial vaginosis increase the risk of?

Answer 27

risk of catching sexually transmitted infections, including chlamydia, gonorrhoea and HIV.

Question 28

What does bacterial vaginosis increase the risk of in pregnant women?

Answer 28

Miscarriage

Preterm delivery

Premature rupture of membranes

Chorioamnionitis

Low birth weight

Postpartum endometritis

Question 29

Management of PID?

Answer 29

Remember: 3 word disease = 3 antibiotics

ceftriaxone, doxycycline and metronidazole