7.4 PID & Infectious Diseases in Gynae

Question 1

Define PID

Answer 1

PID is the ascending infection from the lower to upper genital tract resulting in endometritis > salpingitis > Oophoritis > Peritonitis > Sepsis

Question 2

85% of PID is caused by 3 organisms. What are they? What does the other 15% represent?
What risk factors would you be looking for?

Answer 2

N. Gonorrhoea, C. Trochomatis (chlamydia), Anaerobes or bacterial vaginosis
The other 15% represent those non-sexually transmitted enteric/resp pathogens that colonise the lower genital tract.

RFs: Age <25, Recent IUD insertion (esp within 6 weeks), Septic termination of pregnancy.

Question 3

What urine should be obtained for the diagnosis of PID?

Answer 3

First catch urine or endocervical swab (like in booking clinic)

Question 4

What is the clinical presentation of PID

Answer 4

Chlamydia sx but more severe: Chronic pelvic pain, sub fertility, ectopic pregnancy, perihepatic adhesions.
+ !Adnexal tenderness (on exam)
+ Heavy menstrual bleeding, IMB, Post-coital bleeding
+ Cervical excitation

Question 5

What is cervical excitation?

Answer 5

Cervical excitation = Cervical motion tenderness on pelvic exam

Question 6

How would you diagnose PID?

Answer 6

First catch urine/endocervical swab. NAAT PCR for for C and G. 3/4 criteria for bacterial vaginosis, serology for Syphilis, HIV screen. Always do BhCG, she could just be pregnant.

+ clinical presentation of PID

Question 7

What is your first and second line treatment for PID?

Answer 7

Ceftriaxone 500mg IM stat + Metronidazole AND Ofloxacin both 400mg BD for 14 days

Second line: Laparoscopy

Abscess –> US-guided drainage