13) Pelvic Inflammatory Disease

Question 1

What is pelvic inflammatory disease?

Answer 1

Result of an infection ascending from endocervix, causing multiple infections of the tissues it ascends through

Question 2

What is a tubo-ovarian abscess?

Answer 2

Encapsulated or confined ‘pocket of pus’ with defined boundaries that forms during an infection of a fallopian tube and ovary

Question 3

What is Fitz-Hugh-Curtis syndrome?

Answer 3

RUQ pain and peri-hepatitis after chlamydia infection

Question 4

What is Reiter’s syndrome?

Answer 4

Disseminated chlamydial infection

‘Can’t see, can’t pee, can’t bend at knee’

Question 5

What are the causative organisms in PID?

Answer 5

Polymicrobial
N. gonorrhoea, C. trachomatis
Others: gardnerella, mycoplasma, anaerobes

Question 6

What are the risk factors for PID?

Answer 6

Sexually active women (20-30)
Lack of barrier contraception
Multiple sexual partners 
Low social class
Intrauterine contraceptive device

Question 7

What are some of the signs and symptoms of PID?

Answer 7

Pyrexia
Pain (lower abdomen, dyspareunia)
Discharge
Bleeding

Question 8

What investigations can be carried out if PID is suspected?

Answer 8

Pregnancy test
Endocervical and high vaginal swabs
Blood test
STI screen 
Laparoscopy

Question 9

What is the management of PID?

Answer 9

Empirical treatment

Contact tracing

Question 10

What antibiotic therapy can be offered for PID?

Answer 10

IM ceftriaxone, doxycycline and metronidazole

Question 11

What surgical treatment can be offered for PID?

Answer 11

Laparoscopy/laparotomy

If no response to treatment, severe or tubo-ovarian abscess

Question 12

What are some differential diagnoses for the symptoms of PID?

Answer 12

Functional pain
UTI
Appendicitis or IBD syndrome 
Ectopic pregnancy 
Endometriosis 
Ovarian cyst

Question 13

When would IV antibiotics be given for PID?

Answer 13

If severe - fever, peritonitis, tubo-ovarian abscess