Pelvic Inflammatory Disease

Question 1

What is a polymicrobial infection of the upper genital tract?

Answer 1

Pelvic Inflammatory Disease

Question 2

What disease is commonly associated with the following:

1. Neisseria Gonorrhoeae and Chlamydia Trachomatis
2. Endogenous organisms, including anaerobes
3. Haemophilus Influenzae
4. Enteric gram-negative rods
5. Streptococci

Answer 2

Pelvic Inflammatory Disease

Question 3

What is most common in young, nulliparous, sexually active women with multiple partners and is a leading cause of infertility and ectopic pregnancy?

Answer 3

Pelvic Inflammatory Disease

Question 4

True or False

Acute PID is highly unlikely when recent (within 60 days) intercourse has not taken place. So history is important.

Answer 4

True

Question 5

True or False

Women with cervical motion, uterine, or adnexal tenderness should be considered to have PID and be treated with antibiotics unless there is a competing diagnosis such as ectopic pregnancy or appendicitis

Answer 5

True

Question 6

These are some signs and symptoms of what disease?

1. Lower abdominal pain
2. chills and fever
3. menstrual disturbances
4. purulent cervical discharge
5. cervical and adnexal tenderness
6. many women have subtle/mild symptoms such as:
   a. postcoital bleeding
   b. urinary frequency
   c. low back pain

Answer 6

Pelvic Inflammatory Disease

Question 7

What labs should be done for a patient with suspected PID?

Answer 7

1. endocervical culture

2. Pregnancy test

Question 8

What imaging can used to diagnose PID?

Answer 8

Laparoscopy

1. if diagnosis is not certain
2. patient has not responded to antibiotic therapy after 48 hrs

Question 9

What are some early treatments with appropriate antibiotics that are effective against Gonorrhea and Chlamydia?

Answer 9

1. Cefoxitin (Mefoxin) 2g IM and alternatively Doxycycline 100mg PO BID x14 days
2. Ceftriaxone 500mg IM and alternatively Doxycycline 100mg PO BID x14 days
3. Metronidazole 500mg PO BID x14 days
   a. may be added to treat BV

Question 10

What is the treatment for severe PID?

Answer 10

Cefoxitin (Mefoxin) 2g IV Q 6hrs and Doxycycline 100mg PO or IV Q 12hrs

Question 11

Tubo-ovarian abscesses are a common complication of PID and may require what?

Answer 11

Surgery

Question 12

Long-term sequelae of PID such as chronic pelvic pain, dyspareunia, ectopic pregnancy, and infertility (common), develop in how many women with acute disease?

Answer 12

1/4 of women with acute disease

Question 13

Patient with PID presenting with any of the following warrants what disposition?

1. patient has or is suspected of having a tubo-ovarian abscess
2. pregnant
3. patient is unable to follow or tolerate outpatient regimen
4. patient has not responded clinically to outpatient therapy within 72 hours
5. patient has severe illness, nausea, vomiting, or high fever not controlled
6. another surgical emergency, such as appendicitis, cannot be ruled out

Answer 13

MEDEVAC