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PID Flashcards

(61 cards)

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1
Q

List some common symptoms of PID.

A
  • Fever
  • Pain
  • Vaginal discharge
  • Abnormal bleeding

Symptoms can vary and may include both obvious signs and more subtle indications.

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2
Q

What is a potential issue with diagnosing PID?

A

Symptoms may be subtle or even absent

This can lead to delays in the diagnosis of subclinical infection.

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3
Q

Which populations are likely to be disproportionately affected by PID?

A

Women in developing countries

These populations may experience higher rates of PID due to various factors.

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4
Q

What is the reported rate of PID in Aboriginal and Torres Strait Islander communities?

A

As high as 32%

This statistic highlights the significant impact of PID in these communities.

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5
Q

What occurs during the ascension of microbes to the upper reproductive tract?

A

Disruption of the normal protective barriers of the lower reproductive tract by causative pathogens

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6
Q

What is the initial site of infection in the reproductive tract?

A

The cervix

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7
Q

What barrier is broken down during the initial infection of the cervix?

A

The mucous plug barrier

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8
Q

When are women particularly susceptible to infection in the reproductive tract?

A

During the mid-cycle

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9
Q

How does uterine peristalsis affect pathogen migration?

A

Facilitates sperm transport, potentially aiding pathogen migration

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10
Q

What physiological event may compound the risk of infection during menses?

A

Loss of the mucous plug and retrograde spill of menstrual fluid into the pelvis

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11
Q

Which pathogens are commonly isolated in women presenting with PID?

A
  • Chlamydia trachomatis
  • Neisseria gonorrhoea
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12
Q

What percentage of women presenting with PID have C. trachomatis or N. gonorrhoea isolated?

A

Approximately one-third to one-half

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13
Q

What recommendations does the RACGP make regarding C. trachomatis screening?

A

Opportunistic screening for sexually active persons aged 15–19 years

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14
Q

Why is opportunistic screening for C. trachomatis recommended in adolescents?

A

Due to the prevalence and risk of complications in this cohort

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15
Q

What type of infection is common after initial infection?

A

Polymicrobial infection

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16
Q

What types of organisms can contribute to polymicrobial infections in the reproductive tract?

A
  • Vaginal facultative organisms
  • Organisms associated with bacterial vaginosis
  • Respiratory and gastrointestinal organisms
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17
Q

Fill in the blank: The ascension of microbes occurs due to _______ of the normal protective barriers.

A

disruption

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18
Q

What are the cervical pathogens associated with pelvic inflammatory disease?

A

Neisseria gonorrhoea, Chlamydia trachomatis, Mycoplasma genitalium

These pathogens are often implicated in sexually transmitted infections leading to pelvic inflammatory disease.

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19
Q

List the bacterial vaginosis pathogens involved in pelvic inflammatory disease.

A
  • Peptostreptococcus species
  • Bacteroides species
  • Atopobium species
  • Leptotrichia species
  • Clostridia species
  • Mycoplasma hominis
  • Ureaplasma urealyticum

Bacterial vaginosis is a condition that can disrupt the normal bacterial flora, contributing to pelvic inflammatory disease.

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20
Q

Which respiratory pathogens are linked to pelvic inflammatory disease?

A
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Group A streptococcus
  • Staphylococcus aureus

These pathogens can cause respiratory infections that may complicate pelvic inflammatory disease.

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21
Q

Identify the enteric pathogens associated with pelvic inflammatory disease.

A
  • Escherichia coli
  • Bacteroides fragilis
  • Group B streptococci
  • Campylobacter species

Enteric pathogens can also be involved in pelvic infections, especially in cases of gastrointestinal flora disruption.

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22
Q

What is the classical presentation of acute pelvic inflammatory disease?

A

Abrupt onset of pain symptoms during or just following menses

Pain is most likely located in the lower abdomen but may be generalized or located in the upper abdomen in certain cases.

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23
Q

Where is pain typically located in acute pelvic inflammatory disease?

A

Lower abdomen, may be generalized, or located in the upper abdomen in cases of perihepatic inflammation

Generalized pain can occur in the setting of peritonism.

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24
Q

What findings are used for the clinical diagnosis of PID?

A

Pelvic organ tenderness, cervical motion tenderness, uterine tenderness, adnexal tenderness, and cervical inflammation

Cervical inflammation is evidenced by discharge, friability, and/or high white blood cell count on microscopic examination.

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25
What samples should be sent for microscopy, culture, and PCR testing in suspected PID cases?
High vaginal and endocervical swabs ## Footnote Endocervical samples are preferred due to superior detection rates.
26
What may also be present in cases of PID aside from clinical symptoms?
Elevated serum inflammatory marker concentrations ## Footnote This indicates a possible infection or inflammation.
27
What should be initiated in cases of high diagnostic suspicion for PID?
Antimicrobial treatment as per local guidelines ## Footnote This can be done pending culture results and antibiotic sensitivities.
28
In what percentage of PID cases will no causative organism be isolated?
20–30% ## Footnote Therefore, initiation of therapy is warranted on clinical grounds alone.
29
What does early and effective antibiotic treatment reduce in PID cases?
Long-term morbidity ## Footnote Subsequent pregnancy rates are two- to threefold higher in the modern antibiotic era.
30
What consideration should be given regarding patients with PID?
Possibility of concurrent pregnancy and broad testing for sexually transmissible infections ## Footnote Appropriate pretest counselling should be performed.
31
What are the major sequelae of PID in women of childbearing age?
Chronic pelvic pain, ectopic pregnancy, infertility ## Footnote PID stands for Pelvic Inflammatory Disease, which can lead to these serious complications.
32
What percentage of women report infertility after PID treatment?
Approximately 18% ## Footnote This statistic highlights the long-term impact of PID on women's reproductive health.
33
What is the range of percentage for ectopic pregnancy in women after PID treatment?
0.6–2.0% ## Footnote Ectopic pregnancy is a serious condition where the embryo implants outside the uterus.
34
What percentage of women experience chronic pelvic pain three years after PID treatment?
30% ## Footnote Chronic pelvic pain can significantly affect the quality of life.
35
How does the degree of fallopian tube damage correlate with infertility risk?
The risk of infertility increases with the degree of damage; may be as high as 30% with severe damage. ## Footnote Laparoscopy is often used to assess the extent of tubal damage.
36
What is the relationship between recurrent infections and infertility in women with a history of PID?
Recurrent infections are associated with a marked increase in the risk of infertility. ## Footnote This underscores the importance of managing recurrent infections effectively.
37
What is an essential component of treatment and post-treatment counselling for women with a history of PID?
Discussion of long-term sequelae and implications for fertility ## Footnote This is crucial for informed family planning and health management.
38
What are important components of treatment counselling for women with a history of PID?
Risk of ectopic pregnancy and need for early pregnancy monitoring ## Footnote Early monitoring can help identify ectopic pregnancies promptly.
39
What percentage of couples experience infertility?
Approximately 15% of couples will experience infertility.
40
What percentage of female infertility cases are attributed to tubal factors?
Tubal factors account for 25–35% of cases of female infertility.
41
What is the primary causative factor of tubal infertility?
Pelvic Inflammatory Disease (PID) is the causative factor in more than half of the cases.
42
What is the risk of tubal infertility after three episodes of PID?
More than 50% of women will have tubal dysfunction.
43
When should couples seeking preconception planning be assessed for infertility?
After 12 months of unprotected intercourse or 6 months if the female partner is aged >35 years.
44
What factors are considered in the assessment of tubal disease severity?
* Presence of a hydrosalpinx * Degree of peritubular adhesions * Preservation of fimbriae * Appearance of the endosalpinx
45
What is the sensitivity and specificity of a hysterosalpingogram?
Sensitivity is 65% and specificity is 83%.
46
What is the gold standard for tubal assessment?
Chromotubation at laparoscopy.
47
What does chromotubation allow for in tubal assessment?
* Assessment of the pelvis * Evaluation of the tubal anatomy * Detection of peritubal adhesions
48
What is the ideal management for couples with tubal infertility based on?
* Female age * Ovarian reserve parameters * Coexisting pelvic pathology * Semen parameters * Socioeconomic factors * Patient preferences
49
What is the success rate for resolution of tubal blockage with transcervical tubal cannulation?
85% of cases report resolution.
50
What is the re-occlusion rate after transcervical tubal cannulation?
30%.
51
What is the pregnancy rate after microsurgical tubocornual anastomosis?
Approximately 48% of women achieve ongoing pregnancies.
52
What are the potential surgical therapies for distal tubal disease?
* Salpingostomy * Fimbrioplasty
53
What is the associated pregnancy rate after salpingostomy?
Approximately 30%.
54
What is a significant risk associated with pregnancy after salpingostomy?
One-quarter of pregnancies may be ectopically sited.
55
What does fimbrioplasty aim to restore?
Fimbrial function and oocyte capture.
56
What cannot be reversed by surgery for distal tubal disease?
Ciliary damage of the tubal epithelium and architecture.
57
What does in vitro fertilisation (IVF) eliminate in conception?
The role of the fallopian tube.
58
What is the chance of successful conception with IVF treatment?
Approximately 30%.
59
What is the most important determinant of IVF success?
Female age.
60
What is recommended in the presence of hydrosalpinges before embryo transfer?
Tubal occlusion or salpingectomy.
61
What effect do hydrosalpinges have on implantation and pregnancy rates?
They have a deleterious effect.

Obsgyn AMC (2 decks)

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