PID and STIs

Question 1

define pelvic inflammatory disease?

Answer 1

Infection ABOVE the cervix (upper genital tract)

Question 2

what are the main causative pathogens that cause STI induced PID?

Answer 2

chlamydia, gonorrhoea, mycoplasma, trichomonas

Question 3

define hydrosalpinx

Answer 3

fluid in the fallopian tube –> can cause issues with fertility

Question 4

what are the likely organisms for bacterial vaginosis?

Answer 4

BV refers to an imbalance of endogenous flora which may cause localised infection, not systemic infection

Question 5

what antibiotics do we use for bacterial vaginosis?

Answer 5

metronidazole or clindamycin (both in the form of vaginal gels/creams)

Question 6

when do we treat bacterial vaginosis?

Answer 6

if the patient is symptomatic
If the patient is pregnant
before any gynaecological procedure

Question 7

what is another causative pathogen for candidiasis (thrush) other than candida albicans

Answer 7

candida glabrata

Question 8

define chronic vaginal candida infection?

Answer 8

more than 4 episodes per year

Question 9

how can we treat acute candidiasis?

Answer 9

acute episode–> caneston (clotrimazole 10%) vaginal cream or single dose fluconazole orally 150mg

Question 10

a young woman comes in with chronic vaginal candidiasis. she is on the COCP. what can we do to reduce recurrence rates of thrush?

Answer 10

change to progesterone only contraception

as candida usually likes high oestrogenic environments

Question 11

what are some risk factors for vulvovaginal candidiasis

Answer 11

long-term broad-spectrum antibiotics, diabetes, oestrogen therapy (e.g. the pill, hormone replacement therapy) and stress.

Question 12

what is a complication of chlamydia/gonorrhoea infection causing PID that we can see on laparoscopy?

Answer 12

Fitz-Hugh–Curtis syndrome, a complication of CT and NG infections, results in perihepatitis and the formation of ‘violin string’ adhesions surrounding the liver.

Question 13

what are some clinical examination findings which may raise suspicion of PID?

Answer 13

• cervical motion tenderness (‘excitation’)
  • uterine tenderness
  • adnexal tenderness
• temperature > 38.3°C
• cervical or vaginal mucopurulent discharge

Question 14

how to manage chlamydia infection?

Answer 14

• Reportable infection
• Azithromycin 1g stat (repeat in 1 week if symptomatic)
• Contact tracing
• A test of cure usually not required but should be obtained in pregnant women, patients with persistent symptoms
• If severe then ceftriaxone 1g IV plus metronidazole 500mg IV plus azithromycin 500mg IV daily; IV antibiotics for 48 hrs

Question 15

which pathogen is associated with IUDs?

Answer 15

actinomyces

Question 16

what are some clinical features of cervicitis?

Answer 16

postcoital bleeding
vaginal discharge
abnormal pap smear

Question 17

how do we treat non-albicans related candidiasis?

Answer 17

boric acid vaginal plessary inserted for 10-14 nights

Question 18

how do you manage a tubo-ovarian abscess secondary to PID?

Answer 18

Abscess needs to be drained or surgically removed

Should have 24-48 hours of IV antibiotics before drainage

Question 19

what are some non-sexually acquired causes of PID?

Answer 19

endogenous pathogen

post surgical (hysteroscopy D&C, insertion of IUD)

retained products of conception

Question 20

what is the antibiotic management of mild-moderate sexually acquired PID?

Answer 20

Ceftriaxone 500mg in 2mL of 1% lignocaine IMI, or 500 mg IV, stat
PLUS
Metronidazole 400mg PO, BD for 14 days
PLUS
Azithromycin 1g PO, stat
PLUS
Doxycycline 100mg PO, BD for 14 days

can be done as an outpatient

Question 21

what is the antibiotic management of severe sexually acquired PID?

Answer 21

Ceftriaxone 2g IV, daily
OR
Cefotaxime 2g IV, TDS
PLUS
Azithromycin 500mg IV, daily
PLUS
Metronidazole 500mg IV, BD

inpatient admission usually required

Question 22

how do we manage actinomyces infection causing PID?

Answer 22

often long term (approx 6 months) course of penicillin based antibiotics with infectious diseases team

Question 23

how do we treat chronic vaginal candidiasis?

Answer 23

fluconazole 150mg oral weekly for 3 months

Question 24

when do we need a test of cure for chlamydia infection post appropriate antibiotic treatment?

Answer 24

when the patient is pregnant or has persistent symptoms or has had suboptimal antibiotic management