Pelvic inflammatory disease

Question 1

Define pelvic inflammatory disease.

Answer 1

Pelvic inflammatory disease (PID) comprises a spectrum of inflammatory disorders of the upper female genital tract, including any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.

Question 2

What is the aetiology of pelvic inflammatory disease?

Answer 2

Neisseria gonorrhoeae and Chlamydia trachomatis are most common. Chlamydia trachomatis comprises 14-35% of all cases and is most common.

Can also be: Gardnerella vaginalis, Haemophilus influenzae, Streptococcus agalactiae, and cytomegalovirus (CMV).

Question 3

What are risk factors for pelvic inflammatory disease?

Answer 3

Prior infection with chlamydia or gonorrhoea

Young age at onset of sexual activity

Unprotected sexual intercourse with multiple sexual partners

Prior history of PID

IUD use

Question 4

Summarise the epidemiology of pelvic inflammatory disease.

Answer 4

Relatively common; in UK ~33.6% of women have experienced PID.

Question 5

What are the signs and symptoms of pelvic inflammatory disease?

Answer 5

Uterine tenderness

Cervical motion tenderness

Adnexal tenderness

Lower abdominal pain

Abnormal cervical or vaginal discharge

Fever

Question 6

What investigations should be performed for a patient with pelvic inflammatory disease?

Answer 6

White blood cell count

Polymorphonuclear cells on wet mount of vaginal secretions

Genetic probe or culture of vaginal secretions for Neisseria gonorrhoeae and Chlamydia trachomatis

Nucleic acid amplification test for Mycoplasma genitalium

Question 7

What is the management for pelvic inflammatory disease?

Answer 7

Parenteral cephalosporin plus oral doxycycline with potential metronidazole adjunct.

If not tolerated, fluroquinolone + metronidazole

Consider removal of IUD if present.

Question 8

What complications can be associated with pelvic inflammatory disease? What is the prognosis of pelvic inflammatory disease?

Answer 8

Tubo-ovarian abscess

Infertility

Chronic pelvic pain

Ectopic pregnancy

Prognosis for complete recovery is good in patients treated within 3 days of symptom onset and who are able to complete the full course of therapy. Clinical and microbiological cure rates of 88% to 100% have been reported after oral antibiotic treatment