What is the pathway of ascending infxns that cause/contribute to PID?
cervicitis --> endometritis --> salpingitis/oophoritis/tubo-ovarian abscess--> peritonitis
What are some risk factors for PID?
- age <25
- young age @ 1st sexual encounter [<15yo]
- use of contraception OTHER THAN barrier/condoms
- Hx of PID
- personal or partner's Hx of gonorrhea/chlamydia
- multiple partners
- current douching
- IUD insertion
- demographics...SES, access to care [this is getting better]
What is a good Diff Dx for PID
- Ovarian cyst, torsion
What has to be present on pelvic exam to diagnose PID?
one or more...
-cervical motion tenderness aka "chandelier sign"
What test is used for PID?
NO SPECIFIC TEST
- swab for STDs
- CRP, ESR, WBC elevations
- US can ID enlarged fallopian tubes or abcess
How is the Diagnosis made for PID?
WHat is the PID spectrum?
- labs & imaging for uncertain cases, failure to respond to Tx or severe illness
PID ranges from Asx'c to life threatening!!!
When should we consider inpatient Tx for PID?
- unable to follow Tx plan or take oral therapy
severely ill [Dr. P's major deciding factor]
- surgical abdomen
- no improvement after 72 hrs
What medications can be given as Tx for PID?
- Ceftriaxone [IM single dose] + Doxycyline [orally 2xday/14days]
- +/- metronidazole
- +/- metronidazole
What is the drug to Tx gonorrhea?
What about chlamydia?
What are possible consequences of PID?
- scarring-->infertility [20%]
- scarring--> ectopic pregnancy [9%]
chronic pelvic pain [18%]
How do we Tx a TOA?
surgical drainage + antibiotics
How should we reduce incidence of PID as clinicians?
annual chlamydia screen for:
-sexually active women <25
-sexually active women >25 at high risk
When should we screen pregnant women?
What is an important [often forgotten] part of Tx'ing a woman with PID?
Tx her partner too!!!
Do we have to report PID?
Yes, cuz its an STD [Gonorrhea & chlamydia are both reportable]
How do we teach our patients about PID?