Pelvic Infection

Question 1

What is PID?

Answer 1

Infection of the upper female genital tract: cervix, uterus, fallopian tubes, ovaries.

Question 2

What does infection of the cervix cause?

Answer 2

Mucopurulent discharge

Question 3

What is the common progression from salpingitis?

Answer 3

Salpingitis (fallopian tubes) usually co-occurs with endometritis. Infection may spread to the ovaries (oophoritis) and then peritoneum (peritonitis).

Question 4

What is the aetiology of PID?

Answer 4

Microorganisms ascending from vagina and cervix into endometrium and fallopian tubes. Common organisms:

• Chlamydia
• Neisseria gonorrhoea
• Mycoplasma genitalium

Question 5

What are the RFx for PID?

Answer 5

• Previous PID
• Presence of bacterial vaginosis or any STD
• younger age
• non caucasian
• low SES
• multiple or new partners

Question 6

What are the signs and symptoms of PID?

Answer 6

-Lower abdo pain
-fever
-cervical discharge
-abnormal uterine bleeding
esp during or after menses

Question 7

What are the signs and symptoms of cervicitis?

Answer 7

-Cervix red and bleeds easily
-Mucuopurulent discharge
(usually yellow green)

Question 8

What are the signs and symptoms of acute salpingitis?

Answer 8

-lower abdo pain
-N/V (with severe pain)
-Irregular bleeding (due to endometritis)
-Fever
SIGNS:
-cervical motion tenderness
-guarding
-rebound tenderness
-dyspareunia / dysuria (rare)

Question 9

Which is more severe: PID due to chlamydia or gonorrhoea?

Answer 9

Gonorrhoea usually more symptomatic and clinically apparent. Chlamydia indolent.

Question 10

What may result following acute gonoccocal or chlamydial salpingitis?

Answer 10

• Fitz-Hugh-Curtis syndrome (perihepatitis causing RUQ pain)
• Chronic infection (intermittent exacerbations and remissions)
• Tubo-ovarian abscess
• Hydrosalpinx
• Tubal scarring / adhesions: chronic pain, infertility, increased risk of ectopic

Question 11

How may tubo-ovarian abscess present?

Answer 11

q- Pain, fever, peritonism

• Adnexal mass palpable
• Extreme tenderness
• Rupture (severe symptoms and septic shock)

Question 12

What is hydrosalpinx?

Answer 12

Fimbrial obstruction and tubal distension with non purulent fluid.

Question 13

When should PID be considered?

Answer 13

Women of reproductive age with:

• lower abdo pain
• cervical / unexplained discharge
• Ireggular bleeding
• Dyspareunia
• Dysuria

Question 14

Investigation of suspected PID?

Answer 14

• PCR (gon and chlam)
• Pregnancy test
• US if tenderness limited PEx

Question 15

Why should US be performed if patient does not respond to ABx in 48h?

Answer 15

Exclude:
- tubo ovarian abscess
- pyosalpinx
- ectopic pregnancy
- adnexal torsion
F/u laparoscopy if US neg

Question 16

How should patients who do not respond to first line (clam and gon) treatment be managed?

Answer 16

Consider PID due to M. genitalium. Treat empirically with moxifloxacin 400mg PO OD for 10 days.

Question 17

When are women with PID hospitalised?

Answer 17

• Uncertain diagnosis (e.g. unable to exclude surgical cause)
• Pregnancy
• Severe symptoms or high fever
• Tubo ovarian abscess
• Inability to tolerate OP therapy
• Lack of response to Rx