Pelvic Inflammatory Disease

Question 1

Define Pelvic Inflammatory Disease (PID)

Answer 1

The result of an infection ascending from the endocervix, causing endometritis, salpingitis, parmetritis, oophoritis, tubo-ovarian abscess and/or pelvic paritonitis

Question 2

Define Endometritis

Answer 2

Inflammation and infection of the endometrium

Question 3

Define Salpingitis

Answer 3

Inflammation of the fallopian tube

Question 4

Define Tubo-Ovarian abscess

Answer 4

Abscesses in the fallopain tube or ovary

Question 5

What is the main group of people that PID affects?

Answer 5

Sexually active women
20-24 years
Higher incidence in urban areas

Question 6

What two main STIs cause PID?

Answer 6

Gonorrhoea (14%)

Chlamydia (39%)

Question 7

What is the pathology behind PID?

Answer 7

Infection ascends from the endocervix and vagina to the uterus. This causes adhesions to form and damage the tubal epithelium

Question 8

What are some of the risk factors for PID?

Answer 8

Sexual behaviour
Type of contraception (IUD increases the risk for the first few weeks)
Alcohol/Drug use
Smoking

Question 9

What are the clinical features for PID?

Answer 9

Pyrexia
Bilateral lower abdominal tenderness, adnexal tenderness, cervical excitation, deep dyspareunia
Abnormal vaginal/cervical discharge
Abnormal vaginal bleeding

Question 10

What investigations can you do for PID?

Answer 10

Endocervical swab (For gonorrhoea and chlamydia)
High vaginal swab (For bacterial vaginosis)
*A negative finding does NOT exclude PID*

Question 11

How do you manage PID?

Answer 11

Analgesia
Antibiotics (14 days oral, IV for more severe cases)
Surgery

Question 12

When would you admit a PID patient to hospital?

Answer 12

Tubo-ovarian abscesses
Severe
Pregnant
Oral therapy doesn't work
Systemically unwell

Question 13

What are the antibiotics used for PID?

Answer 13

Ceftriaxone, Doxycycline, Metranidazole (Makes patient feel sick, reacts with alcohol)

Question 14

What does PID expose patients to?

Answer 14

Ectopic pregnancy, Infertility
Chronic pelvic pain
Fitz Hugh Curtis syndrome

Question 15

What is Fitz Hugh Curtis syndrome?

Answer 15

Inflammation of the peritoneum, diaphragm and perihepatitis

Question 16

What are the symptoms of Fitz Hugh Curtis syndrome?

Answer 16

Severe pain in the URQ
Fever
Chills
Headache
Malaise