Genital Tract Infection - Pelvic Inflammatory Disease

Question 1

What is Pelvic Inflammatory Disease?

Answer 1

Inflammation and infection of the pelvic organs, caused by ascending infection spreading up from the endocervix.

Question 2

Infection of Organs in Pelvic Inflammatory Disease (5).

Answer 2

1. Endometritis - Endometrium.
2. Salpingitis - Fallopian tubes.
3. Oophoritis - Ovaries.
4. Parametritis - Parametrium (Connective Tissue around Uterus).
5. Peritonitis - Peritoneal Membrane.

Question 3

Risk Factors of Pelvic Inflammatory Disease.

Answer 3

1. Young and Sexually Active.
2. Not Using Barrier Contraception.
3. Multiple Sexual Partners.
4. Existing STIs.
5. Previous PID.
6. Intrauterine Device.

Question 4

Aetiology of Pelvic Inflammatory Disease (2C).

Answer 4

1. STI (commoner) :
1A. Gonorrhoea (Severe PID).
1B. Chlamydia.
3. Mycoplasma Genitalium.
2. Non-STI Infections :
A. Gardnerella Vaginalis (BV).
B. H. influenzae.
C. E. coli (enteric bacteria associated with UTIs).

Question 5

Clinical Features of PID (6).

Answer 5

1. Pelvic/Lower Abdominal Pain.
2. Abnormal Vaginal Discharge.
3. Abnormal Bleeding.
4. Dyspareunia.
5. Fever (& Sepsis?).
6. Dysuria.

Question 6

Investigations of PID (6).

Answer 6

1. Examination.
2. Screening for STI.
3. High Vaginal Swab (usually negative).
4. Microscopy.
5. Pregnancy Test (Ectopic).
6. Bloods - Inflammatory Markers.

Question 7

Examination Findings in PID (4).

Answer 7

1. Pelvic Tenderness.
2. Cervical Excitation (Cervical Motion Tenderness).
3. Cervicitis.
4. Purulent Discharge.

Question 8

What STIs are screened for? (4)

Answer 8

1. Chlamydia & Gonorrhoea - NAAT.
2. Mycoplasma Genitalium - NAAT.
3. HIV Test.
4. Syphilis.

Question 9

What is the High Vaginal Swab used for? (3)

Answer 9

1. Bacterial Vaginosis.
2. Candidiasis.
3. Trichomoniasis.

Question 10

Microscope Findings in Pelvic Inflammatory Disease.

Answer 10

Pus Cells on Swabs from Vagina or Endocervix.

Question 11

Management of Pelvic Inflammatory Disease.

Answer 11

1. GUM Clinic Referral.
2. Empirical Antibiotics (based on STIs).
3. Severe/Septic : Admission and IV Antibiotics.
4. Pelvic Abscess - Drainage by Interventional Radiology/Surgery.
5. Review in 4 Weeks.

Question 12

Empirical Antibiotics for Pelvic Inflammatory Disease (2).

Answer 12

1. Oral Ofloxacin + Oral Metronidazole.

2. IM Ceftriazone + Oral Doxycycline + Oral Metronidazole.

Question 13

Complications of Pelvic Inflammatory Disease.

Answer 13

1. Tubular Infertility.
2. Chronic Pelvic Pain.
3. Sepsis.
4. Abscess.
5. Ectopic Pregnancy.
6. Fitz-Hugh-Curtis Syndrome.

Question 14

What is Fitz-Hugh-Curtis Syndrome?

Answer 14

Inflammation and infection of Glisson’s (Liver) Capsule leading to adhesions between liver and peritoneum.

Question 15

Aetiology of Fitz-Hugh-Curtis Syndrome.

Answer 15

Bacterial spread from pelvis via peritoneal cavity, lymphatic system or blood.

Question 16

Clinical Presentation of Fitz-Hugh-Curtis Syndrome.

Answer 16

RUQ Pain that can refer to Right Shoulder Tip.

Question 17

Investigation and Management of Fitz-Hugh-Curtis Syndrome.

Answer 17

Investigation : Laparoscopy.

Management : Adhesiolysis.