10.2: PID Flashcards
What causes PID?
An infection that ascends to the upper genital tract spreading from the endocervix
Name six diseases/complications that PID can lead to?
Which is considered a surgical emergency
Essentially an infection of every part of the genital tract:
- Endometritis
- Salpingitis; inflammation of the Fallopian tubes
- Parametritis; inflammation of pelvic floor CT
- Oophoritis; inflammation of ovary
- Tubo-ovarian abscess; abscess (collection of pus) of the Fallopian tube and/or affecting the ovary
- Pelvic peritonitis; irritation of peritoneum* surgical emergency
What is another name for parametritis?
Pelvic cellulitis
Describe the areas that an individual with PID may experience pain
* 5 things
- Pelvic floor
- Lower abdominal; usually bilateral but can be unilateral
- RUQ
- Deep dyspareunia (especially if recent onset)
- Secondary dysmenorrhea: pain caused by disordered reproductive organs that starts earlier in the menstrual cycle and lasts longer than menstrual cramps
Other than types of pain, what other signs and symptoms might an individual with PID experience?
Abnormal vagina discharge and bleeding
List five gynaecological differentials for PID, star the two that are the most severe and must be dealt with quickly
- Ectopic pregnancy*
- Ruptured corpus lateral cyst
- Endometriosis
- Ovarian cyst rupture
- Ovarian torsion*
Name two potential GI differentials and one renal differential for PID
Other than any gynaecological, GI and renal differentials - what else is a differential for PID?
GI: IBS and diverticular disease
Renal: UTI (particularly if its unilateral pain and there’s associated dysuria)
Other: functional pain and appendicitis (especially if its R iliac fossa pain)
What is Mittleshmerz pain?
Another gynaecological differential for PID, its mid-cycle cramping due to ovulation which can be very severe
Name four risk factors for a PID specific to sexual behaviour
- Early age of first sexual intercourse
- Multiple partners
- New partner <3 months
- History of STIs (patient or partner)
Name three risk factors for a PID specific to instrumentation of the uterus
- Termination of a pregnancy
- IUD insertion within last 4-6 weeks (if so consider removing it after no response to antibiotics within 72 hours)
- Recent IVF
Name four bacterial causes for PID, which is the most common? Is there always a pathogen involved?
- Chlamydia- most common
- Gonorrhea
- Mycoplasma genitalium
- Overgrowth of natural vaginal flora; anaerobes, gardnerella vaginalis
*But it can also be pathogen negative
What would you expect to see in an abdominal, bimanual/pelvic and speculum (to see inside hollow body parts) examination of a patient with PID. What else might the patient present with?
Abdominal: lower (usually bilateral) abdominal tenderness
Bimanual: adnexal, cervical and uterine tenderness
Speculum: abnormal cervical and vaginal mucopurulent discharge
The patient may also have a fever
What is the adnexa?
Region adjacent to the uterus that includes the ovary, Fallopian tubes and associated structures
Name five major investigations you would do for a patient with suspected PID
- Pregnancy test
- Triple swab:
A) high vaginal swab to rule out bacterial infections and candidiasis
B) Endocervical swab for chlamydia and gonorrhea - Bloods: ESR, CRP, leukocyte count and check for HIV and syphilis
- Ultrasound: looking for hydrosalpinx (clear serous fluid within the Fallopian tube) or an abscess
- CT/MRI to exclude any other diagnosis
List three major/general things you would do as part of PID treatment
- GUM referral for advice, contact tracing, and screening current and recent partners within last 6 months
- Analgesia; i.e paracetamol, ibuprofen
- Empirical (not waiting for swabs to come back, treat quickly to avoid complications) antibiotics for 14 days
- outpatient and inpatient regime. The course of antibiotics must be finished even if the swabs come back negative