pelvic inflammatory disease Flashcards
what are the risk factors for developing PID ?
young age early age of first intercourse multiple sexual partners recent new sexual partners History of STI recent instrumentation
what are the symptoms of PID ?
lower abdominal pain which is typically bilateral
deep dyspareunia
abnormal vaginal bleeding
abnormal vaginal discharge
what are the signs of PID ?
lower abdominal tenderness which is usually bilateral
adnexal tenderness on bimanual vaginal examination
cervical motion tenderness
fever
what are the differential diagnosis of lower abdominal pain in young women ?
ectopic pregnancy acute appendicitis endometriosis UTI IBS Ovarian cyst torsion or rupture
what are the risks or complications associated with PID ?
infertility ectopic pregnancy chronic pelvic pain Fitz-hugh-Curtis Syndrome Tubo-ovarian abscess
what investigations should be performed in a patient with PID ?
pregnancy test urine analysis and culture Wet mount vaginal smear test for gonorrhea and chlamydia ESR and C reactive protein Laparoscopy
what is the significance of using wet mount vaginal smear ?
a good negative predictor in the case of absence of pus cells
what is the management for PID ?
in any young woman complaining of lower abdominal pain that is bilateral , given that pregnancy has been excluded a broad spectrum antibiotic should be given that cover both chlamydia and gonorrhea and anaerobic infections
after prescribing medication when should the patient be reviewed ?
should be reviewed at 72 hours and advised not to have any unprotected sexual intercourse until she is done with her treatment
what are the possible outpatients regimens that the patient should take ?
- ceftriaxone + doxycycline + metranidazole
- oral olfaxcin + metranidazole
- Ceftriaxone + azithromycin
when should surgical intervention or inpatient therapy be considered ?
- surgical emergency cannot be excluded
- lack of response or intolerance to oral therapy
- presence of tubo-ovarian abscess
- pregnancy
what is the inpatient regimen ?
IV ceftriaxone + doxycycline followed by oral doxycycline and oral metranidazole
what is the inpatient therapy for a woman who is pregnant and has a PID ?
depending on the isolated organism but amoxycillin and erythromycin can be used
which antibiotics should not be used in pregnancy ?
tetracyclines
when is surgical management indicated ?
Indicated in severe cases or where there is clear evidence of a pelvic abscess
