Pelvic Inflammatory Disease

Question 1

What are the causes of acute pelvic inflammatory disease?

Answer 1

1. Usually ascending infection from endocervix (e.g. STI, uterine instrumentation)
2. Can descend from other infected organs (e.g. appendicitis)

Question 2

What are the most common causes of acute pelvic inflammatory disease?

Answer 2

Chlamydia and gonorrhoea

Question 3

What are the risk factors for acute pelvic inflammatory disease?

Answer 3

<25 years, history of STIs, new/multiple sexual partners, lower socio-economic status, sexually active, nulliparous, woman.

Question 4

What are the main protective factors for acute pelvic inflammatory disease?

Answer 4

Barrier contraception, Mirena IUS, COCP.

Question 5

What is this a presentation of?
Woman with acute bilateral lower abdominal pain, deep dyspareunia, vaginal discharge, IMB/PCB, fever, dysuria, lower back pain.

Answer 5

Acute pelvic inflammatory disease

Question 6

How is suspected acute pelvic inflammatory disease investigated?

Answer 6

1. Vulvovaginal and endocervical swabs for chlamydia and gonorrhoea, MCS.
2. Pregnancy test to exclude ectopic
3. Acutely unwell - FBC, CRP, blood cultures of sepsis
4. TVUSS if abscess suspected
5. Laparoscopy if diagnostic uncertainty

Question 7

What is the management for acute inflammatory disease?

Answer 7

1. Start treatment before cultures
2. Contact trace sexual partners and treat before resumption of sexual activity
3. Triple antibiotic therapy - ceftriaxone 500mg IM and doxycycline 100mg PO BD and metronidazole 400mg PO BD
4. Increases doses if severe symptoms, sepsis, or symptoms fail to respond.

Question 8

What are the complications of acute pelvic inflammatory disease?

Answer 8

1. Abscess formation
2. Tubal obstruction, subfertility
3. Ectopic pregnancy
4. Chronic pelvic infection/chronic pelvic pain
5. Fitz-Hugh-Curtis syndrome (Perihepatitis)

Question 9

What is the pathophysiology of chronic pelvic inflammatory disease?

Answer 9

Inflammation leads to fibrosis, adhesions develop between pelvic organs. Tubes may become distended with pus or fluid.

Question 10

What is this a presentation of?
Woman with chronic dysmenorrhoea, deep dyspareunia, heavy and irregular menstruation, chronic vaginal discharge and subfertility.

Answer 10

Chronic pelvic inflammatory disease

Question 11

How is chronic pelvic inflammatory disease investigated?

Answer 11

1. Examination may reveal features similar to endometriosis (abdominal and adnexal tenderness and fixed retroverted uterus)
2. TVUSS - fluid in fallopian tubes or surrounding adhesions
3. Laparoscopy is the best diagnostic tool