Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

Inflammation of the upper female genital tract

Question 2

What structures can PID affect, and what would this cause in each case?

Answer 2

Endometrium - endometritis
Uterine tubes - salpingitis
Ovaries - oophritis
Parametrium - parametritis
Peritoneum - peritonitis
Tubo-ovarian abscess

Question 3

What are the causes of PID?

Answer 3

STIs
- most commonly chlamydia/gonorrhoea
- other examples are mycoplasma sp.
Commensal bacteria from the vagina 
Often unknown

Question 4

What are risk factors for PID?

Answer 4

Young age (<25)
New sexual partner
IUD use

Question 5

What is the presentation of PID?

Answer 5

Lower abdominal/pelvic pain (usually bilateral)
Dyspareunia
Abnormal dischargee
Abnormal uterine bleeding (post-coital, intermenstrual)

Question 6

In PID if adnexal tendeness/mass on bimanual examination is found, what should be suspected?

Answer 6

Tubo-ovarian abscess

Question 7

What investigations should be done for PID?

Answer 7

Vulvovaginal swabs and NAAT for chlamydia/gonorrhoea + full sexual health screen
Midstream urine sample for culture and sensitivity
Pregnancy test to exclude
FBC, CRP
Transvaginal scan if tuba-ovarian abscess suspected

Question 8

What are differentials for PID?

Answer 8

Ectopic pregnancy
Endometriosis
Functional pain
UTI
IBS
Acute appendicitis
Ovarian cyst complications

Question 9

How is endometriosis differentiated from PID?

Answer 9

Endometriosis symptoms are associated with menstrual cycle

Question 10

How is UTI differentiated from PID?

Answer 10

Dysuria, frequency

Question 11

How is IBS differentiated from PID?

Answer 11

Disturbance in bowel habit, bloating, persistence of symptoms over a long period

Question 12

How is appendicitis differentiated from PID?

Answer 12

Nausea and vomiting common, site of pain

Question 13

How are ovarian cyst complications differentiated from PID?

Answer 13

Very sudden onset

Question 14

Should PID be referred to gynaecology?

Answer 14

Yes

Question 15

What antibiotics should generally be prescribed for PID?

Answer 15

Metronidazole + ofloxacin

Question 16

What antibiotics should be prescribed for PID if high risk for gonorrhoea?

Answer 16

IM ceftriaxone single dose + doxycycline + metronidazole

Question 17

What antibiotics should be prescribed for PID if disease is severe (inpatient needed)?

Answer 17

IV ceftriaxone + IV metronidazole + PO doxycycline
IV Azithromycin if oral doxy not able to take
Step down to PO doxy + metronidazole

Question 18

What is done next if PID does not settle with antibiotics?

Answer 18

Pelvic imaging

Question 19

How is a pelvic abscess treated?

Answer 19

Surgical drainage

Question 20

What are complications of PID?

Answer 20

Scarring and narrowing of uterine tubes
- infertility
- ectopic pregnancy
Peri-hepatitis
Chronic pelvic pain

Question 21

How can scarring of uterine tubes be treated?

Answer 21

Laparoscopic removal of scarring and adhesions after acute inflammation has resolved

Question 22

What symptom in PID suggests peri-hepatitis?

Answer 22

Right upper quadrant pain