Flashcards in PID/pelvic infection Deck (21)
What is PID? What are the two main organisms responsible for PID?
Pelvic inflammatory disease - an acute, ascending infection of upper female genital tract. Main causes - Neisseria gonorrhoea and Chlamydia trachomatis
Name 3 risk factors for PID
Unprotected sexual activity with multiple partners
Previous Hx of STIs or PID
Name 4 common symptoms of PID
Bilateral pelvic pain
Abnormal vaginal bleeding or discharge
Name 5 findings on examination consistent with PID. Which is the most sensitive sign?
Temp > 38
Lower abdominal tenderness
Discharge on vaginal examination
Purulent exudate on endocervix on speculum examination
Cervical excitation, uterine tenderness and/or adnexal tenderness on bimanual examination - most sensitive
Name 4 initial investigations to order for PID and expected results
FBE - elevated WCC
Wet mount of vaginal secretions - PMNs present
ESR - elevated
PCR or culture of vaginal secretions for Neisseria gonorrhoea and chlamydia - if +ve, 100% specificity for PID (but not all PID will be +ve)
What effect does an IUD have on the incidence of PID? What organism is associated with IUD-related PID?
Doesn’t increase incidence, but makes any infection worse
Associated with actinomyces (but need to distinguish b/w colonisation and infection)
Name 4 complications of PID. What organism is most closely associated with these complications?
Ectopic pregnancy (can cause adhesion around fallopian type)
Hydro/pyosalpinx - fallopian tube filled with fluid/pus from distal obstruction
Fitz-Hugh-Curtis syndrome (perihepatitis from peritoneal spread of organisms to capsule of liver)
Chlamydia more likely to cause complications
What is the usual empirical management of mild-moderate PID?
Stat oral azithromycin and IM/IV ceftriaxone + 14 days of oral metronidazole + either 14 days oral doxycycline, or another stat dose of oral azithromycin 1 week later (if pregnant or non adherent to doxycycline)
Consider removal of IUD
What is the empirical management of severe PID?
IV ceftriaxone/cefotaxime + oral azithromycin or IV metronidazole
What is cervicitis? What usually causes it?
Inflammation of cervix - can be infectious (usually chlamydia or gonorrhoea) or non-infectious
How does cervicitis usually present? Name 2 Ddx for this presentation. Name 2 other symptoms of cervicitis
Post-coital bleeding. Other causes - ectropion, or cervical Ca. Other symptoms - purulent vaginal/cervical discharge, dysuria and increased urinary frequency
What is the most sensitive sign on examination for cervicitis?
Easily induced cervical bleeding ('friable')
Name 3 investigations if suspicious of cervicitis
FBE - elevated WCC
Wet mount of cervical discharges - raised LMNs
NAAT of vaginal or cervical swabs for chlamydia and gonorrhoea
Pap smear and colposcopy - exclude Ca
What is vaginitis? Name 3 separate etiological causes of the disease, and risk factors for each of these causes.
Inflammation of vagina
Bacterial vaginosis - multiple sexual partners
Candidiasis - risk factor: high oestrogen, previous antibiotics
Chemical irritation (soaps, sweat from tight clothing, laundry powder) - risk factor: poor/excessive vulval care
Hormonal deficiency (atrophic vaginitis from decreasing oestrogen levels) - risk factor: menopause
Name 3 common symptoms of vaginitis
Vaginal discharge, dysuria, itching, dyspareunia
What is the textbook description of discharge from bacterial vaginosis vs candidiasis?
Bacterial vaginosis - white-grey discharge
Candidiasis - cottage cheese discharge
What is a potential complication of untreated vaginal candidiasis?
Vulvavaginitis (chronic pain)
What is the standard treatment for Chlamydia infection?
Oral azithromycin stat, or oral doxycycline for 10 days
Name 3 Ddxs for vaginal discharge
Neoplasm (usually watery, sometimes blood-stained)
Endometriosis of cervix or vagina (cyclical brown/bloody discharge)
Name 6 gynaecological Ddxs of acute pelvic pain
Not related to menstrual cycle:
Haemorrhaging/torsion/rupture of ovarian cyst
Lower genital tract (vaginitis, cervicitis)
Upper genital tract (PID, endometritis, tubo-ovarian abscess)
Related to menstrual cycle: