Infection - Pelvic inflammatory disease

Question 1

What is PID?

Answer 1

Ascending infection of genital tract

Mostly caused by chlamydia then gonorrhoea

Question 2

What bits can get inflammed?

Answer 2

Endometritis
Salpingitis
Oopheritis
Peritonitis

Question 3

Risk factors for PID?

Answer 3

Multiple partners
Under 25 (undeveloped cervix)
Douching
IUD insertion
Iatrogenic

Question 4

Presentation of PID?

Answer 4

**Lower abdo pain which is bilateral **

Fever

Deep dyspareunia

Dysuria / menstrual irregularities

Vaginal / cervical discharge

Cervical excitation** (chandelier’s sign)**

Question 5

Investigation for PID?

Answer 5

Pregnancy test to exclude ectopic

High vaginal swab - BV, Candidiasis, trichomoniasis

Endocervical swab NAAT - chlamydia, gonorrhoea

so : triple swab (2 endocervical + high vaginal)

if no pus cells on miscroscope can help exclude PID

Question 6

How to manage PID?

Answer 6

epirical abx first thing before swab results!

Combo of abx to cover everything and anything:

CEF, DOX, MET

Ceftriaxone 1g 1M
Doxycycline 100mg 2x daily
Metronidazole 400mg 2x daily

Question 7

What will with ceftriaxone cover?

Answer 7

gonorrhoea

Question 8

What will the doxycycline cover

Answer 8

chlamydia and mycoplasma

Question 9

What does metronidazole cover?

Answer 9

anaerobes - gardnerella

Question 10

If PID septic signs or PID in a pregnant patient?

Answer 10

IV ABX = hospital admission

Question 11

What is fitz-hugh-curtis syndrome?

Answer 11

liver capsule - glisson’s capsule

• adhesions between the liver and peritoneum

right upper quadrant pain to right shoulder tip (diaphragm irritation)

-> laparoscopy can be used to visualise and also treat the adhesions by adhesiolysis