Inflammatory and Infective Disorders

Question 1

Chronic pelvic pain is defined as pelvic pain which lasts how long?

What are the most common causes for this?

Answer 1

More than 6 months

Endometriosis and PID

Question 2

What is endometriosis?

How common is it?

Answer 2

The presence of endometrial glands and stroma, outwith the uterine cavity

5-10% of women of reproductive age, 40% of women with subfertility and 80% of women with chronic pelvic pain

Question 3

What are the main 3 clinical features of endometriosis?

Answer 3

Cyclical ppelvic pain

Dyspareunia

Subfertility

Question 4

What is the first imaging investigation you may do for endometriosis and what might it show?

What is the gold standard investigation?

Answer 4

TVUS - will see endometriod ‘chocolate’ cysts in the ovaries (seen in 20-40% of women with endometriosis)

Laparoscopy

Question 5

The management of endometriosis depends on what? Why?

Answer 5

The woman’s fertility plans - there is no medical management for women who want to conceive in the near future

Question 6

What is the aim of medical management for endometriosis?

What are some options?

If this treatment is still not sufficient what can you add?

Answer 6

To suppress ovulation and induce amenorrhoea

Essentially any kind of contraception (COCP, POP, implant, IUS, depot)

An NSAID for pain relief

Question 7

Removal of endometriomas which are > 6cm helps with what?

Answer 7

To improve fertility rates

Question 8

What is the prognosis of endometriosis?

Answer 8

It goes away spontaneously in 1/3rd of women, for the others it is a chronic condition.

Typically, symptoms get better after the menopause

Question 9

What is PID?

What are the most common causes?

Answer 9

An ascending infection of the upper female genital tract

Chlamydia and gonorrhoea

Question 10

What are some risk factors for PID?

Answer 10

Aged < 25

Multiple sexual partners

Unprotected sex

Recent IUD insertion

Question 11

How can the risk of PID be reduced?

Answer 11

Use of barrier contraceptives

Giving women at high risk of STIs prophylactic antibiotics before insertion of the IUD

Question 12

Ascending genital tract infection causes what?

In rare cases, what can develop?

Answer 12

Cervicitis, endometritis, salpingitis

Tubo-ovarian abscesses

Question 13

What are some symptoms of PID?

Answer 13

Severe lower abdominal pain

Abnormal vaginal bleeding

Offensive vaginal discharge

Question 14

What are some examination findings of PID?

Answer 14

Pyrexia

Cervical excitation

Adnexal tenderness and swelling

Question 15

What blood tests are useful in the diagnosis of PID?

What microbiological investigation would you do?

What imaging investigations would you do?

What investigation is used as a last resort?

Answer 15

WCC and CRP

NAATs for chlamydia and gonorrhoea

Transvaginal US or MRI

Laparoscopy

Question 16

If you are investigating for PID and perihepatic lesions are found - what does this suggest?

This is most often a complication of what?

Answer 16

Fitz-Hugh-Curtis syndrome

Chlamydia infection

Question 17

How is PID treated?

Answer 17

Broad spectrum antibiotics

Question 18

PID has a good prognosis if caught and treated early. If not, what are some potential complications?

Answer 18

Chronic pelvic pain

Pelvic adhesions

Ectopic pregnancy

Sub/infertility