Obs & Gynae Flashcards
PID cause
Pelvic inflammatory disease (PID) is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum. It is usually the result of ascending infection from the endocervix.
Causative organisms
Chlamydia trachomatis: the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis
PID symptoms
lower abdominal pain
fever
deep dyspareunia
dysuria and menstrual irregularities may occur
vaginal or cervical discharge
cervical excitation
PID Investigation
a pregnancy test should be done to exclude an ectopic pregnancy
high vaginal swab - these are often negative
screen for Chlamydia and Gonorrhoea
PID management
Low threshold for treatment due to complications
first-line: stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole - this now considered first-line due to the desire to avoid systemic fluoroquinolones where possible
second-line: oral ofloxacin + oral metronidazole
RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ‘ Removal of the IUD should be considered and may be associated with better short term clinical outcomes’
PID complications
perihepatitis (Fitz-Hugh Curtis Syndrome)
occurs in around 10% of cases
it is characterised by right upper quadrant pain and may be confused with cholecystitis
infertility - the risk may be as high as 10-20% after a single episode
chronic pelvic pain
ectopic pregnancy
