Pelvic Infection

Question 1

What is PID?

Answer 1

• Acute infection of any organ above the cervix
• Usually STI-related ascending infection but also pregnancy, invasive procedure-related.
  
  • Other abdominal processes can spread downwards e.g. diverticulitis

Question 2

What organisms commonly cause PID?

Answer 2

• N. gonorrhoea, C. trachomatis, M. genitalium, others like E.coli
• Interruption of the endocervical barrier by a pathogen, allowing vaginal bacteria access to the upper genital tract organs. Always a polymicrobial infection regardless of initiating pathogen

Question 3

List some risk factors for PID

Answer 3

• Sex (especially multiple sexual partners), younger age, partner with an STI, previous STI
  
  • IUD increases risk for 3 weeks post-insertion only

Question 4

What clinical features on presentation might you expect in a woman with PID?

Answer 4

• Lower abdominal pain
  
  • Recent onset, worse during sex, starts during or after menses (blood - growth medium), usually bilateral
• Intermenstrual bleeding
• Vaginal discharge
• UTI features
• Examination features
  
  • Diffuse tenderness, rebound tenderness, marked tenderness in RUQ (liver adhesions - Fitz-Hugh-Curtis)
  • Purulent endocervical discharge and cervical inflammation
  • Acute cervical/adnexal tenderness

Question 5

Describe the management of a woman with acute PID

Answer 5

• Admit if severe disease/pregnant/immunocompromised/abscess/no response to medical treatment
• Mild/moderate disease
  
  • Azithromycin stat (chlamydia), ceftrixone stat (gonorrhoea), send home with metronidazole and doxycycline (polymicrobial)
  • Others if not STI
• Severe disease
  
  • IV azithromycin and ceftriaxone and metronidazole
  • Consider removal of IUD, drainage of abscess
• Notify health department if chlamydia or gonorrhoea
• Discuss safe sex, contraception

Question 6

What are some complications of PID?

Answer 6

• Ectopic pregnancies
• Infertility
• Chronic pelvic pain (adhesions)