PELVIC INFLAMMATORY DISEASE Flashcards
What is pelvic inflammatory disease?
An infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis.
What are the most common organisms responsible for pelvic inflammatory disease?
Chlamydia trachomatis
Neisseria gonorrhea
Mycoplasma genitalium
What is the organism that is the most common cause of pelvic inflammatory disease in the UK?
Chlamydia trachomatis
Pelvic inflammatory disease is not always a primary infection. What other sites or types of infection might lead to pelvic inflammatory disease?
Appendicitis
Tuberculosis
What are the risk factors for the development of pelvic inflammatory disease?
Age under 25
Marital status: single
Sexual history: multiple sexual partners
Medical history: past history of STI or PID
recent instrumentation of uterus (e.g. termination)
Use of intrauterine contraceptive device, especially insertion within 3 weeks
What are some of the common symptoms associated with pelvic inflammatory disease, which you must ask about in a history?
Pelvic or lower abdominal pain usually bilateral Deep dyspareunia Dysmenorrhoea Abnormal or increased vaginal discharge Fever
What percentage of people with pelvic inflammatory disease caused by chlamydia are asymptomatic?
80%
What symptoms of pelvic inflammatory disease might make you suspect chlamydia as the causative organism?
Post-coital or intermenstrual bleeding
Lower abdominal pain
Purulent vaginal discharge
Dysuria
What percentage of people with pelvic inflammatory disease caused by gonorrhoea are asymptomatic?
50%
What symptoms of pelvic inflammatory disease might make you suspect gonorrhoea as the causative organism?
Increased or altered vaginal discharge
Lower abdominal pain
Dysuria
What percentage of people with pelvic inflammatory disease caused by anaerobes such as mycoplasma are asymptomatic?
50%
What symptoms of pelvic inflammatory disease might make you suspect anaerobes such as mycoplasma as the causative organism?
Offensive fishy-smelling discharge
What investigations should be done with someone in whom you suspect pelvic inflammatory disease?
FBC
CRP
ESR
Blood cultures
Swabs - low and high vaginal, endocervical, urethral. These are now examined using nucleic acid amplification tests (NAATs) rather than immuno-assays.
Mid stream urine sample
Pregnancy test (urinary beta-hCG)
Ultrasound to rule out complications
What are the short term complications of pelvic inflammatory disease?
Pelvic abscess formation
Septicaemia
Septic shock
What are the long term complications of pelvic inflammatory disease?
Infertility
Increased likelihood of ectopic pregnancy
Chronic pelvic pain
Dyspareunia
Menstrual disturbances
Psychological effects
Fitz-Hugh-Curtis syndrome
What are the features of Fitz-Hugh-Curtis syndrome, a rare complication of pelvic inflammatory disease?
Perihepatitis (inflammation of the liver capsule) leading to adhesions
Right upper quadrant abdominal pain
What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by chlamydia? Try to include dose.
Chlamydia is a gram negative bacteria
Doxycycline 100 mg bd for 7 days
or
Azithromycin 1g stat
What would you give a pregnant lady who is found to have pelvic inflammatory disease caused by chlamydia?
Erythromycin 500 mg bd
What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by gonorrhoea? Try to include dose.
Ceftriaxone 250 mg IM stat or Cefixime 400 mg PO stat or Spectinomycin 2 g IM stat or Ciprofloxacin 500 mg PO stat
What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by anaerobes such as mycoplasma and gardnerella? Try to include dose.
Metronidazole 400 mg bd for 7 days
What might you find on examination that would indicate that the patient was suffering from pelvic inflammatory disease?
Tachycardia Raised temperature Abdominal tenderness Purulent vaginal discharge Cervical motion tenderness Adnexal (area next to uterus) tenderness or swelling
What is the microorganism responsible for causing syphilis?
Treponema pallidum
What antibiotic therapy should be given for someone with syphilis?
First line: benzylpenicillin G given IM
Alternatives: doxycycline (not used in pregnancy)
What is the Jarisch-Herxheimer reaction?
A reaction sometimes seen following treatment of syphilis. It is thought to be due to the release of endotoxins following bacterial death.
What are the clinical features of the Jarisch-Herxheimer reaction to antibiotic therapy to treat syphilis?
Fever, rash, tachycardia after first dose of antibiotic.
Typically occurs within a few hours of treatment.
