Pelvic Inflammatory Disease

Question 1

What organs can PID affect?

Answer 1

Endometrium - endometritis
Fallopian tubes - salpingitis
Oophoritis - ovaries
Parametritis- parametrium
Peritonitis- peritoneal membrane

Question 2

Causes of PID?

Answer 2

Neisseria gonorrhoea- more severe PID

Chlamydia trachomatis

Mycoplasma genitalium

Can less commonly be caused by non STIs:
Gardnerella vaginalis, haemophilus influenza, E coli

Question 3

Risk factors for PID?

Answer 3

Not using barrier protection
Multiple sexual partners
Younger age
Existing STIs
Previous PID
Intrauterine device

Question 4

Presentation of PID?

Answer 4

Pelvic/lower abdo pain
Abnormal discharge
Abnormal bleeding (intermenstrual or postcoital)
Pain during sex
Fever
Dysuria

O/E:
Pelvic tenderness, cervical motion tenderness,
Inflamed cervix
Purulent discharge

Question 5

Investigations for PID?

Answer 5

NAAT swab
HIV test
Syphilis test

High vaginal swab (look for BV, candidiasis and trichomonas)

Pregnanct test

Inflammatory markers will be raised

Question 6

PID management?

Answer 6

Refer to GUM for management and contact tracing.

Single dose IM ceftriaxone (covers gonorrhoea)
AND
Doxy 14 days
Metronidazole 14 days

Severe cases require admission for IV abx

Question 7

Complications of PID?

Answer 7

Sepsis
Abscess
Infertility
Chronic pelvic pain
Ectopic pregnancy

Fitz-Hugh-Curtis syndrome:
Inflammation of liver capsule, causing adhesions between liver and peritoneum = RUQ pain