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A - MSRA Gynaecology [8] > [7] Pelvic Inflammatory Disease > Flashcards

[7] Pelvic Inflammatory Disease Flashcards

1
Q

What is pelvic inflammatory disease (PID)?

A

An infection of the upper genital tract in females which affects the uterus, fallopian tubes and ovaries

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2
Q

How common is PID?

A

Relatively common

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3
Q

How many people are diagnosed with PID in primary care each year?

A

280/100,000 people

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4
Q

What age group has the highest prevalence of PID?

A

15-24

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5
Q

What causes PID?

A

Spread of bacterial infection from the vagina or cervix to the upper genital tract

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6
Q

What are the most common causative organisms of PID?

A
  • Chlamydia trachomatis

- Neiserria gonorrhoea

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7
Q

What % of PID cases are caused by chlamydia and gonorrhoea?

A

25%

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8
Q

What are the risk factors for PID?

A
  • Sexually active
  • Age 15-24
  • Recent partner change
  • Intercourse without barrier contraceptive protection
  • History of STIs
  • Personal history of PID
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9
Q

How can PID occur through non-sexual transmission?

A
  • Gynaecological surgery
  • Termination of pregnancy
  • Insertion of intrauterine copper device
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10
Q

What are the symptoms of PID?

A
  • Lower abdominal pain
  • Deep dyspareunia
  • Menstrual abnormalities
  • Post-coital bleeding
  • Dysuria
  • Abnormal vaginal discharge
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11
Q

What menstrual abnormalities can occur in PID?

A
  • Menorrhagia
  • Dysmenorrhoea
  • Intermenstrual bleeding
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12
Q

What features of vaginal discharge are suggestive of PID?

A
  • Purulent

- Unpleasant odour

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13
Q

What are the features of advanced PID?

A
  • Severe lower abdominal pain
  • Fever
  • Nausea
  • Vomiting
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14
Q

What features may be present on examination in PID?

A
  • Uterine/adnexal tenderness
  • Cervical excitation
  • Palpable mass in lower abdomen
  • Abnormal vaginal discharge
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15
Q

What are the differentials for PID?

A
  • Ectopic pregnancy
  • Ruptured ovarian cyst
  • Endometriosis
  • UTI
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16
Q

What is the aim of investigations of PID?

A

Identify the infective organism

17
Q

What swabs should be taken in suspected PID?

A
  • Endocervical swabs

- High vaginal swabs

18
Q

What organisms are tested for by endocervical swabs for PID?

A
  • Gonorrhoea

- Chlamydia

19
Q

What organisms are tested for by high vaginal swabs in PID?

A
  • Trichomona vaginalis

- Bacterial vaginosis

20
Q

What test is performed on swabs for PID?

A

Nucleic acid amplification test (NAAT)

21
Q

Do negative swabs exclude PID?

A

No

22
Q

What additional investigations may be useful in PID?

A
  • Full STI screen
  • Urine dipstick
  • Pregnancy test
  • Transvaginal USS
  • Laparoscopy
23
Q

What can urinalysis in suspected PID help exclude?

A

UTI

24
Q

Why may a laparoscopy be required in suspected PID?

A

To observe for gross inflammatory changes and to obtain peritoneal biopsy

25
Q

When is a laparoscopy indicated for PID?

A

In severe cases where there is uncertainty

26
Q

How is PID managed?

A

Broad spectrum antibiotics for 14 days

27
Q

What are the antibiotic options for treating PID?

A
  • Doxycycline, ceftriaxone and metronidazole

- Ofloxacin and metronidazole

28
Q

What advice should be given to patients with PID?

A
  • Rest
  • Avoid sexual intercourse
  • All sexual partners for last 6 months should be tested and treated
29
Q

When should women with PID be admitted to hospital?

A
  • If pregnant
  • Severe symptoms
  • Signs of pelvic peritonitis
  • Unresponsive to oral abx
  • Need fore emergency surgery
30
Q

What can cause an increased risk of complications of PID?

A
  • Recurrent infections

- Delaying treatment

31
Q

What are the potential long-term complications of PID?

A
  • Ectopic pregnancy
  • Infertility
  • Tubo-ovarian abscess
  • Chronic pelvic pain
  • Fits-Hugh Curtis syndrome
32
Q

What causes the increased risk of ectopic pregnancy following PID?

A

Narrowing and scarring of the fallopian tubes

33
Q

What proportion of people with PID have infertility?

A

1 in 10

34
Q

What is Fitz-Hugh Curtis syndrome?

A

Peri-hepatitis that typically causes RUQ pain

A - MSRA Gynaecology [8] (52 decks)

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