Pelvic Inflammatory Disease

Question 1

Definition of PID

Answer 1

An ascending infection of the female upper genital tract
- may be acute or chronic
With a spectrum of disease
- endometritis
- salpingitis
- oophoritis
- tubo-ovarian abscess
- local/ pelvic and generalised peritonitis

Question 2

Who gets PID?

Answer 2

• women of reproductive age

- usually sexually transmitted

Question 3

Definition of secondary PID

Answer 3

• infection from elsewhere in the body spreads to the upper genital structures

Question 4

Another name for acute PID

Answer 4

Acute salpingo-oophoritis

Question 5

Definition of chronic PID

Answer 5

• complications of acute PID (adhesions, fibrosis) cause frozen pelvis
• chronic infective process of the pelvis (TB, schisto)

Question 6

Differentials of PID

Answer 6

• endometriosis
• chronic ectopic pregnancy
• chronic bladder and bowel conditions

Question 7

Risk factors for PID

Answer 7

• earl sexual debut
• age <25
• promiscuity
• low parity
• previous PID/STI
• concomitant STI
• low SES
• BV

Question 8

Protective factors for PID

Answer 8

• barrier contraception
• oral contraception
• tubal ligation
• pregnancy

Question 9

Most common organisms causing PID (primary invaders)

Answer 9

• Chlamydia trachomatis
• Neisseria gonorrhoea
• anaerobes (Gardnerella vaginalis and Mycoplasma hominis)

Question 10

Common secondary invaders in PID

Answer 10

• E. coli
• peptostroptococcus
• S. Faecalis
• anaerobes

Question 11

Pathogenesis of PID

Answer 11

• progressive inflammation, sweeling and hyperaemia of fallopian tubes
• causes tubal adhesion
• tubal ostia become occluded
• pelvic peritonitis
• pyosalpinx/ tubo-ovarian abscess
• generalised peritonitis

Question 12

Symptoms of PID

Answer 12

• lower abdo pain
• offensive discharge
• fever
• urinary frequency/ dysuria
• irregular vaginal bleeding

Question 13

Signs of PID

Answer 13

• sick-looking patient
• pyrexial, tachycardic
• lower abdo tenderness, pelvic and generalised peritonitis
• mucopurulent vaginal discharge
• cervical excitation tenderness
• uterine tenderness
• bilateral adnexal tenderness

Question 14

What is Fitz-Hugh-Curtis syndrome?

Answer 14

• PID is complicated by peri-hepatitis

Question 15

How is PID classified?

Answer 15

The Gainesville system

Question 16

Stages of the Gainesville system

Answer 16

1: early salpingitis (apyrexial)
2: late salpingitis (pyrexial)
3: pyosalpinx/ tubo-ovarian abscess
4: ruptured tubo-ovarian complex, general peritonitis, septicaemia
5: ARDS

Question 17

Treatment of stage 1 PID

Answer 17

• hospital admission not usually required

- empiric oral antibiotics/ oral analgesia

Question 18

Treatment of stage 2 PID

Answer 18

• usually require hospital admission
• empiric oral and IV AB
• often opiate analgesia

Question 19

Treatment of stage 3 and 4 PID

Answer 19

• hospital admission always
• empiric oral and IV AB
• opiate analgesia
• allow 48 hrs to respond to Rx
• surgery

Question 20

Indications for admission for PID

Answer 20

• acute PID with signs of local/generalised perinoteal irritation
• temp >38
• nausea and vomiting
• failure to respond to oral therapy
• intolerance to oral medication
• uncertain diagnosis
• HIV
• unreliable to follow-up

Question 21

Oral AB for PID

Answer 21

• cefixime
• doxycycline
• metronidazole

Question 22

IV AB for PID

Answer 22

• ampicillin
• gentamycin
• metronidazole

Question 23

Surgical methods for PID

Answer 23

• laparotomy
• laparoscopy
• US guided drainage of pus
• posterior colpotomy