10- Pelvic Inflammatory Disease Flashcards
Pelvic inflammatory disease (PID)
is inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix. It is a significant cause of tubular infertility and chronic pelvic pain.
organs which can be affected by PID
- Endometritis is inflammation of the endometrium
- Salpingitis is inflammation of the fallopian tubes
- Oophoritis is inflammation of the ovaries
- Parametritis is inflammation of the parametrium, which is the connective tissue around the uterus
- Peritonitis is inflammation of the peritoneal membrane
causes of PID: STI
- Neisseria gonorrhoeae tends to produce more severe PID
- Chlamydia trachomatis
- Mycoplasma genitalium
causes of PID: N-STI
- Gardnerella vaginalis (associated with bacterial vaginosis)
- Haemophilus influenzae (a bacteria often associated with respiratory infections)
- Escherichia coli (an enteric bacteria commonly associated with urinary tract infections)
risk factors of PID
- Not using barrier contraception
- Multiple sexual partners
- Younger age
- Existing sexually transmitted infections
- Previous pelvic inflammatory disease
- Intrauterine device (e.g. copper coil)
presentation of PID
- Pelvic or lower abdominal pain
- Abnormal vaginal discharge
- Abnormal bleeding (intermenstrual or postcoital)
- Pain during sex (dyspareunia)
- Fever
- Dysuria
examination findings of someone with PID
- Pelvic tenderness
- Cervical motion tenderness (cervical excitation)
- Inflamed cervix (cervicitis)
- Purulent discharge
- Fever
investigations for PID
- swabs
- microscopy
- pregnancy test
- inflammatory markers
swabs used to investigate PID
- NAAT swabs for gonorrhoea and chlamydia
- NAAT swabs for Mycoplasma genitalium if available
- HIV test
- Syphilis test
- A high vaginal swab can be used to look for bacterial vaginosis, candidiasis and trichomoniasis.
microscopy findings in PID
Pus cells
Pus cells are a collection of dead, white blood cells that accumulates when the body’s immune system activates in response to an infection. These cells form a whitish-yellow or yellowish colored protein rich fluid at the site of the infection.
management of PID
antibitoics given empirically before swab results taken
One regime
- A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)
- Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium)
- Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)
management of pregnant patient with PID
require admission to hospital for IV antibiotics
management of pelvic abscess caused by PID
may need drainage by interventional radiology or surgery
complications of PID
- Sepsis
- Abscess
- Infertility
- Chronic pelvic pain
- Ectopic pregnancy
- Fitz-Hugh-Curtis syndrome
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