[7] Pelvic Inflammatory Disease Flashcards
What is pelvic inflammatory disease (PID)?
An infection of the upper genital tract in females which affects the uterus, fallopian tubes and ovaries
How common is PID?
Relatively common
How many people are diagnosed with PID in primary care each year?
280/100,000 people
What age group has the highest prevalence of PID?
15-24
What causes PID?
Spread of bacterial infection from the vagina or cervix to the upper genital tract
What are the most common causative organisms of PID?
- Chlamydia trachomatis
- Neiserria gonorrhoea
What % of PID cases are caused by chlamydia and gonorrhoea?
25%
What are the risk factors for PID?
- Sexually active
- Age 15-24
- Recent partner change
- Intercourse without barrier contraceptive protection
- History of STIs
- Personal history of PID
How can PID occur through non-sexual transmission?
- Gynaecological surgery
- Termination of pregnancy
- Insertion of intrauterine copper device
What are the symptoms of PID?
- Lower abdominal pain
- Deep dyspareunia
- Menstrual abnormalities
- Post-coital bleeding
- Dysuria
- Abnormal vaginal discharge
What menstrual abnormalities can occur in PID?
- Menorrhagia
- Dysmenorrhoea
- Intermenstrual bleeding
What features of vaginal discharge are suggestive of PID?
- Purulent
- Unpleasant odour
What are the features of advanced PID?
- Severe lower abdominal pain
- Fever
- Nausea
- Vomiting
What features may be present on examination in PID?
- Uterine/adnexal tenderness
- Cervical excitation
- Palpable mass in lower abdomen
- Abnormal vaginal discharge
What are the differentials for PID?
- Ectopic pregnancy
- Ruptured ovarian cyst
- Endometriosis
- UTI
What is the aim of investigations of PID?
Identify the infective organism
What swabs should be taken in suspected PID?
- Endocervical swabs
- High vaginal swabs
What organisms are tested for by endocervical swabs for PID?
- Gonorrhoea
- Chlamydia
What organisms are tested for by high vaginal swabs in PID?
- Trichomona vaginalis
- Bacterial vaginosis
What test is performed on swabs for PID?
Nucleic acid amplification test (NAAT)
Do negative swabs exclude PID?
No
What additional investigations may be useful in PID?
- Full STI screen
- Urine dipstick
- Pregnancy test
- Transvaginal USS
- Laparoscopy
What can urinalysis in suspected PID help exclude?
UTI
Why may a laparoscopy be required in suspected PID?
To observe for gross inflammatory changes and to obtain peritoneal biopsy
When is a laparoscopy indicated for PID?
In severe cases where there is uncertainty
How is PID managed?
Broad spectrum antibiotics for 14 days
What are the antibiotic options for treating PID?
- Doxycycline, ceftriaxone and metronidazole
- Ofloxacin and metronidazole
What advice should be given to patients with PID?
- Rest
- Avoid sexual intercourse
- All sexual partners for last 6 months should be tested and treated
When should women with PID be admitted to hospital?
- If pregnant
- Severe symptoms
- Signs of pelvic peritonitis
- Unresponsive to oral abx
- Need fore emergency surgery
What can cause an increased risk of complications of PID?
- Recurrent infections
- Delaying treatment
What are the potential long-term complications of PID?
- Ectopic pregnancy
- Infertility
- Tubo-ovarian abscess
- Chronic pelvic pain
- Fits-Hugh Curtis syndrome
What causes the increased risk of ectopic pregnancy following PID?
Narrowing and scarring of the fallopian tubes
What proportion of people with PID have infertility?
1 in 10
What is Fitz-Hugh Curtis syndrome?
Peri-hepatitis that typically causes RUQ pain
