Exam 2 - PID

Question 1

Most common organisms causing PID

Answer 1

• Gonorrhea
• Chlamydia trachomatis
• Gardnerella
• Haemophilus
• Mycoplasma

Question 2

What is the MOA of these organisms that cause PID?

Answer 2

Organisms ascend from the vagina to upper GU organs –> cause inflammation and scarring

Question 3

PID: adverse effects

Answer 3

• Tubal abscess
• Peritonitis
• Endometritis
• Inflammation and scarring of fallopian tubes
• Increased risk of ectopic pregnancy, infertility

Question 4

PID: risk factors

Answer 4

• Recent insertion of IUD
• Adolescent and young age
• New or multiple sexual partners
• Recent abortion, pelvic surgery, childbirth

Question 5

PID: sign and symptoms

Answer 5

• Bleeding and abnormal discharge
• Dyspareunia
• Abdominal pain or tenderness
  
  • Chronic pelvic pain can be r/t BV
• Fever greater than 101 degrees
• Untreated PID can lead to perihepatitis, tubal ovarian abscess

Question 6

PID: diagnosis requirements

Answer 6

Pelvic or lower abdominal pain AND minimum of the following criteria -

• Cervical motion tenderness
• Uterine tenderness
• Adnexal tenderness

Question 7

PID: diagnosis requirements (additional criteria)

Answer 7

Meeting any of the following can improve specificity of diagnosis

• Fever 101 degrees or greater
• Mucopurulent cervical or vaginal discharge
• Numerous WBCs present on wet prep
• Elevated ESR
• Elevated CRP
• Documented infection with chlamydia or gonorrhea

Question 8

PID: imaging

Answer 8

Transvaginal ultrasound, MRI

• Reveals thickened, fluid-filled tubes with/without free pelvic fluid in tubal ovarian complex

Laparoscopy - direct visualization

Histopathologic evidence of endometritis provides definitive diagosis

Question 9

PID: differential diagnoses

Answer 9

• Ectopic pregnancy
• Endometritis
• Ovarian cysts
• Pelvic adhesions
• IBD
• Acute appendicitis

Question 10

PID: treatment

Answer 10

• Can be empirically treated without waiting for results (including sexual partners)
• Metronidazole to cover potential anaerobes
• IUD does NOT have to be removed unless symptoms are not improving after 2-3 days of antibiotic therapy

Emergent treatment required for patients who do not show improve with antibiotics within 72 hours

• Symptoms: high fever, N/V, appendicitis, ovarian abscess

Question 11

PID: patient education

Answer 11

• Encourage HIV testing
• Encourage use of condoms and other practices to decrease STI transmission
• Refrain from sex until therapy is completed, symptoms have resolved, and sexual partners have completed treated