PID/pelvic infection Flashcards Preview

A1. Women's Health > PID/pelvic infection > Flashcards

Flashcards in PID/pelvic infection Deck (21):
1

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

2

Name 3 risk factors for PID

Unprotected sexual activity with multiple partners
Previous Hx of STIs or PID
IUD insertion

3

Name 4 common symptoms of PID

Bilateral pelvic pain
N&V
Deep dyspareunia
Abnormal vaginal bleeding or discharge

4

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

5

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)

6

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)

7

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
Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome (perihepatitis from peritoneal spread of organisms to capsule of liver)

Chlamydia more likely to cause complications

8

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)

Contact tracing

Consider removal of IUD

9

What is the empirical management of severe PID?

IV ceftriaxone/cefotaxime + oral azithromycin or IV metronidazole

10

What is cervicitis? What usually causes it?

Inflammation of cervix - can be infectious (usually chlamydia or gonorrhoea) or non-infectious

11

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

12

What is the most sensitive sign on examination for cervicitis?

Easily induced cervical bleeding ('friable')

13

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

14

What is vaginitis? Name 3 separate etiological causes of the disease, and risk factors for each of these causes.

Inflammation of vagina

Infection
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

15

Name 3 common symptoms of vaginitis

Vaginal discharge, dysuria, itching, dyspareunia

16

What is the textbook description of discharge from bacterial vaginosis vs candidiasis?

Bacterial vaginosis - white-grey discharge
Candidiasis - cottage cheese discharge

17

What is a potential complication of untreated vaginal candidiasis?

Vulvavaginitis (chronic pain)

18

What is the standard treatment for Chlamydia infection?

Oral azithromycin stat, or oral doxycycline for 10 days

19

Name 3 Ddxs for vaginal discharge

Infection
Neoplasm (usually watery, sometimes blood-stained)
Endometriosis of cervix or vagina (cyclical brown/bloody discharge)
Foreign body

20

Name 6 gynaecological Ddxs of acute pelvic pain

Pregnancy:
Ectopic
Threatened/incomplete miscarriage

Non-pregnancy:
Not related to menstrual cycle:
Haemorrhaging/torsion/rupture of ovarian cyst
Infection
Lower genital tract (vaginitis, cervicitis)
Upper genital tract (PID, endometritis, tubo-ovarian abscess)
Related to menstrual cycle:
Mittelschmerz
Dysmenorrhoea

21

Name 8 non-gynaecological Ddx of acute pelvic pain

GIT:
appendicitis
bowel obstruction
diverticulitis
IBD

Genitourinary tract:
Cystitis
Pyelonephritis
Renal calculus

MSK:
- Hernia