Pelvic Inflammatory Disease

Question 0

What are the differentials for PID

Answer 0

Endometriosis, genital TB, chronic ectopic pregnancy, ovarian cyst (rupture, torsion, infection), appendicitis, UTI (pyelonephritis, cystitis).

Question 1

Define PID

Answer 1

PID is an ascending infection of the upper genital tract in sexually active women. The infection ascends via the cervix in the uterus into the Fallopian tubes out into the ovaries.

Question 2

What are protective measures against PID

Answer 2

Pregnancy (thick cervical mucous protects) tubal ligation, COC, barrier method,

Question 3

List the risk factors

Answer 3

Early sexual debut 
Age <25 
Low parity 
Multiple sex partners 
Previous PID, STI. 
Current STI
Low SES. 
Bacterial vaginosis.

Question 4

Common organisms which cause primary invasion

Answer 4

Chlamydia trachomatis
Neisseria Gonorrhoea
Anaerobes- gardnerella vaginalis

Question 5

What are the common symptoms and signs of PID

Answer 5

Symptoms
Lower abdominal pain, mucopurulent offensive discharge, fever, frequency and dysuria, irregular vaginal bleeding.

Signs
Unwell, pyrexia, tachycardia, lower abdominal tenderness later pelvic and eventual general peritonitis, mucopurulent vaginal discharge, cervical motion tenderness, uterine tenderness, adnexal tenderness.

Question 6

What are the stages of PID.

Answer 6

Stage I- early salpingitis, mild to moderate tenderness located to adnexa, apyrexial,
Stage II- late salpingitis, severe adnexal tenderness and pelvic peritonitis, pyrexial
Stage III- pyosalpinx or tubo-ovarian complex
Stage IV- ruptured tubo-ovarian complex, general peritonitis, septicaemia
Stage V- ARDS

Question 7

What investigations would you perform

Answer 7

Urine pregnancy test, urine disptix analysis, WCC, HIV and syphillis test, PAP smear, transvaginal USS (not always indicated).

Question 8

What are the indications for admission

Answer 8

Signs of general peritoneal irritation(severe tenderness, guarding, rebound) 
Stage III or higher 
Temp- higher that 38 degrees 
Nausea and vomiting 
Failure to respond to oral therapy 
Intolerance of oral therapy 
Uncertain diagnosis. 
HIV 
unreliable patients for follow up.

Question 9

What is the antibiotic regime to treat PID

Answer 9

Cephalosporin (cefixime) oral or ampicillin IV- N. gonnorrhoea
Doxycycline oral or gentamicin IV- chlamydia trachomatis
Metronidazole- anaerobes

Question 10

When is transvaginal USS indicated

Answer 10

Supports diagnosis of PID when dilated Fallopian tubes, tubo-ovarian complex, free fluid in pelvis is seen. Thus helping to guide surgical intervention.

Question 11

What are the surgical methods to treat PID

Answer 11

Laparotomy- examine abdomen for collections,drain pus, abscesses and complexes. Hysterectomy in some cases. Peritoneal wash with normal saline.
Laparoscopy- where’re diagnosis is uncertain.
Ultrasound guided drainage of pus- uncommon
Posterior colpotomy- enter pouch of Douglas through the vagina to drain central collections