PID Flashcards
(11 cards)
What is the definition of Pelvic Inflammatory Disease (PID)?
a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures. It is caused by the ascending spread of microorganisms from the cervicovaginal canal to the contiguous pelvic structures, and cervicitis is not included. The clinical syndrome is not related to pregnancy and surgery.
What are the main risk factors for PID?
The main risk factors include age (high incidence at 15 - 25 years old), sexual activity (young first - time intercourse, multiple partners, frequent intercourse, and STD - positive partners), lower genital tract infections, infection after intrauterine operations, poor sexual hygiene, direct spread of adjacent organ inflammation, and recurrent acute attacks of PID.
Name the primary organisms causing PID.
The primary organisms causing PID are Neisseria gonorrhoeae (about 30%), Chlamydia trachomatis (about 30%), and Mycoplasma hominis (about 10%).
According to the CDC 2015 criteria, what are the minimum diagnostic criteria for PID?
The minimum criteria are adnexal tenderness, cervical motion tenderness, and uterine tenderness
What are the possible complications of PID?
Immediate complications include pelvic peritonitis or generalized peritonitis, and septicemia leading to arthritis or myocarditis. Late complications are dyspareunia, infertility (12% after one episode, 25% after two, 50% after three), chronic pelvic inflammation, formation of adhesions, hydrosalpinx, pyosalpinx or tubo - ovarian abscess, chronic pelvic pain and ill health (24 - 75%), and an increased risk of ectopic pregnancy (6 - 10 fold).
What is the principle of PID treatment?
The principles are to control the infection energetically, prevent infertility and late sequelae, and prevent reinfection.
When should a patient with PID be hospitalized for treatment?
A patient should be hospitalized if there is a suspected tubo - ovarian abscess, severe illness with vomiting and a temperature > 38°C, an uncertain diagnosis where surgical emergencies (like appendicitis) cannot be excluded, no response to outpatient therapy after 48 hours, intolerance to oral antibiotics, co - existing pregnancy, or known HIV infection.
What are the preventive measures for PID?
Preventive measures include educating patients to avoid reinfection and its potential hazards, warning against multiple sexual partners, using condoms, and tracing and treating sexual partners. If partners have non - gonococcal urethritis, they should be treated with tetracycline or doxycycline.
What are the differences in symptoms between acute salpingitis, acute appendicitis, and disturbed ectopic pregnancy?
Acute salpingitis has bilateral lower abdominal pain, may have unrelated amenorrhea and PV bleeding, inconsistent GI symptoms, a flushed face, normal tongue, a rapid pulse proportionate to temperature, more raised temperature, bilateral lower abdominal tenderness, and tenderness on both fornices with a possible mass. Acute appendicitis has pain starting near the umbilicus and settling in the right iliac fossa, unrelated amenorrhea and PV bleeding, usual GI symptoms, a toxic look, a furred tongue, a rapid pulse out of proportion to temperature, slightly raised temperature, tenderness on McBurney’s point with possible muscle guard, and tenderness on the right fornix and high up. Disturbed ectopic pregnancy has acute lower abdominal pain on one side, usually has amenorrhea and PV bleeding, absent GI symptoms, a pale face, a pale tongue, a persistent rise in pulse even with normal temperature, lower abdominal tenderness more on one side, and a mass felt through one fornix extending to the pouch of Douglas
What are the treatment regimens for outpatient PID treatment according to the CDC - 2006 guidelines?
Regimen A: Levofloxacin 500mg (or ofloxacin 400 mg) PO once daily with or without Metronidazole 500 PO bid. Regimen B: Ceftriaxone 250 mg IM single dose PLUS Doxycycline 100 mg PO bid with or without Metronidazole 500 mg PO bid for 14 days.
