S9) Pelvic Inflammatory Disease

Question 1

What is pelvic inflammatory disease?

Answer 1

- Pelvic inflammatory disease is the infection of the female upper genital tract which ascends from the endocervix

• It presents with endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis

Question 2

In four steps, describe the pathophysiology of Pelvic Inflammatory Disease

Answer 2

⇒ Ascending infection from the endocervix & vagina

⇒ Infection causes inflammation

⇒ Inflammation causes damage to tubal epithelium

⇒ Adhesions form

Question 3

What is endometritis?

Answer 3

Endometritis is the inflammation and infection of the endometrium lining of the uterus

Question 4

What is salpingitis?

Answer 4

Salpingitis is the inflammation and infection of the uterine tubes

Question 5

What is parametritis?

Answer 5

Parametritis is the inflammation of the uterine ligaments and parametrium (connective tissue adjacent to the uterus)

Question 6

What is oophoritis?

Answer 6

Oophoritis is the inflammation of the ovaries, often arising due to infection and often accompanied with salpingitis

Question 7

What is a tubo-ovarian abscess?

Answer 7

• A tubo-ovarian abscess is an encapsulated pocket of pus which forms due to infection of the fallopian tubes and ovaries
• It is a late complication of PID and can be life-threatening if the abscess ruptures and results in sepsis

Question 8

What is pelvic peritonitis?

Answer 8

Pelvic peritonitis is the inflammation and infection of the peritoneum, which is the membrane that lines the abdomen in the pelvic area, often occurring as a complication of salpingitis

Question 9

Identify the two commonest organisms which cause PID

Answer 9

Sexually transmitted infections:

• Chlamydia trachomatis
• Neiserria gonorrhoea

Question 10

Identify 4 other organisms which commonly cause PID

Answer 10

• Gardnerella vaginalis
• Mycoplasma hominis
• Anaerobes
• Actinomycosis

Question 11

Which group of people have a high incidence of PID?

Answer 11

Sexually active women (20-30 years old)

Question 12

Identify 5 risk factors for pelvic inflammatory disease

Answer 12

• Young age
• Lack of use of barrier contraception
• Multiple sexual partners
• Low socioeconomic class
• Intrauterine contraceptive device (IUCD)

Question 13

Identify 6 symptoms of PID

Answer 13

• Pyrexia
• Lower abdominal pain
• Deep dyspareunia
• Abnormal vaginal/cervical discharge
• Abnormal vaginal bleeding

Question 14

Describe 5 features observed during the examination of a typical patient with PID

Answer 14

• Fever
• Lower abdominal tenderness (bilateral)
• Lower genital tract infection
• Purulent cervical discharge
• Cervicitis

Question 15

Provide a differential diagnosis of PID in terms of bladder, bowel and gynaecological conditions respectively

Answer 15

• Bladder conditions – UTI
• Bowel conditions – IBS, appendicitis
• Gynaecological conditions – ectopic pregnancy, endometriosis, ovarian cyst complications

Question 16

What investigations would one perform to establish the diagnosis of PID?

Answer 16

• Urinary and/or serum pregnancy test
• Endocervical and high vaginal swabs (NG/CT supports diagnosis)
• Blood tests (WBC & CRP)
• Screening for other STIs
• Diagnostic laparoscopy (gold standard)

Question 17

Briefly outline the management of PID

Answer 17

• Symptomatic management with analgesia and rest
• Management of sepsis
• Severe disease requires IV antibiotics, admission for observation and possibly surgical intervention

Question 18

Describe the surgical management of PID

Answer 18

Laparoscopy/laparotomy may be considered if:

• No response to therapy
• Clinically severe disease
• Presence of a tubo-ovarian abscess

Question 19

Identify the 3 antibiotics used for the treatment of PID

Answer 19

• Ceftriaxone
• Doxycycline
• Metronidazole

Question 20

Identify 5 complications of PID

Answer 20

• Ectopic pregnancy
• Infertility
• Chronic pelvic pain
• Fitz-Hugh-Curtis syndrome
• Reiter syndrome