PELVIC INFLAMMATORY DISEASE Flashcards

1
Q

What is pelvic inflammatory disease?

A

An infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis.

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2
Q

What are the most common organisms responsible for pelvic inflammatory disease?

A

Chlamydia trachomatis
Neisseria gonorrhea
Mycoplasma genitalium

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3
Q

What is the organism that is the most common cause of pelvic inflammatory disease in the UK?

A

Chlamydia trachomatis

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4
Q

Pelvic inflammatory disease is not always a primary infection. What other sites or types of infection might lead to pelvic inflammatory disease?

A

Appendicitis

Tuberculosis

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5
Q

What are the risk factors for the development of pelvic inflammatory disease?

A

Age under 25

Marital status: single

Sexual history: multiple sexual partners

Medical history: past history of STI or PID
recent instrumentation of uterus (e.g. termination)

Use of intrauterine contraceptive device, especially insertion within 3 weeks

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6
Q

What are some of the common symptoms associated with pelvic inflammatory disease, which you must ask about in a history?

A
Pelvic or lower abdominal pain usually bilateral
Deep dyspareunia
Dysmenorrhoea
Abnormal or increased vaginal discharge
Fever
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7
Q

What percentage of people with pelvic inflammatory disease caused by chlamydia are asymptomatic?

A

80%

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8
Q

What symptoms of pelvic inflammatory disease might make you suspect chlamydia as the causative organism?

A

Post-coital or intermenstrual bleeding

Lower abdominal pain

Purulent vaginal discharge

Dysuria

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9
Q

What percentage of people with pelvic inflammatory disease caused by gonorrhoea are asymptomatic?

A

50%

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10
Q

What symptoms of pelvic inflammatory disease might make you suspect gonorrhoea as the causative organism?

A

Increased or altered vaginal discharge

Lower abdominal pain

Dysuria

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11
Q

What percentage of people with pelvic inflammatory disease caused by anaerobes such as mycoplasma are asymptomatic?

A

50%

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12
Q

What symptoms of pelvic inflammatory disease might make you suspect anaerobes such as mycoplasma as the causative organism?

A

Offensive fishy-smelling discharge

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13
Q

What investigations should be done with someone in whom you suspect pelvic inflammatory disease?

A

FBC
CRP
ESR
Blood cultures

Swabs - low and high vaginal, endocervical, urethral. These are now examined using nucleic acid amplification tests (NAATs) rather than immuno-assays.

Mid stream urine sample

Pregnancy test (urinary beta-hCG)

Ultrasound to rule out complications

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14
Q

What are the short term complications of pelvic inflammatory disease?

A

Pelvic abscess formation

Septicaemia

Septic shock

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15
Q

What are the long term complications of pelvic inflammatory disease?

A

Infertility

Increased likelihood of ectopic pregnancy

Chronic pelvic pain

Dyspareunia

Menstrual disturbances

Psychological effects

Fitz-Hugh-Curtis syndrome

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16
Q

What are the features of Fitz-Hugh-Curtis syndrome, a rare complication of pelvic inflammatory disease?

A

Perihepatitis (inflammation of the liver capsule) leading to adhesions

Right upper quadrant abdominal pain

17
Q

What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by chlamydia? Try to include dose.

A

Chlamydia is a gram negative bacteria

Doxycycline 100 mg bd for 7 days
or
Azithromycin 1g stat

18
Q

What would you give a pregnant lady who is found to have pelvic inflammatory disease caused by chlamydia?

A

Erythromycin 500 mg bd

19
Q

What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by gonorrhoea? Try to include dose.

A
Ceftriaxone 250 mg IM stat
or
Cefixime 400 mg PO stat
or
Spectinomycin 2 g IM stat
or
Ciprofloxacin 500 mg PO stat
20
Q

What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by anaerobes such as mycoplasma and gardnerella? Try to include dose.

A

Metronidazole 400 mg bd for 7 days

21
Q

What might you find on examination that would indicate that the patient was suffering from pelvic inflammatory disease?

A
Tachycardia
Raised temperature
Abdominal tenderness
Purulent vaginal discharge
Cervical motion tenderness
Adnexal (area next to uterus) tenderness or swelling
22
Q

What is the microorganism responsible for causing syphilis?

A

Treponema pallidum

23
Q

What antibiotic therapy should be given for someone with syphilis?

A

First line: benzylpenicillin G given IM

Alternatives: doxycycline (not used in pregnancy)

24
Q

What is the Jarisch-Herxheimer reaction?

A

A reaction sometimes seen following treatment of syphilis. It is thought to be due to the release of endotoxins following bacterial death.

25
Q

What are the clinical features of the Jarisch-Herxheimer reaction to antibiotic therapy to treat syphilis?

A

Fever, rash, tachycardia after first dose of antibiotic.

Typically occurs within a few hours of treatment.