Pelvic Inflammatory Disease Flashcards
Common symptoms of PID (6)
- asymptomatic
- bilateral LAP
- deep dyspareunia
- abnormal discharge
- right upper quadrant pain
- fever
Risk factors for PID (7)
- age <25yo
- multiple sexual partners
- HIV pos
- early age coitarche
- new partner
- personal or partner sti
- uterine instrumentation
Investigation for PID (7)
- pregnancy test
- msu
- wet mount
- hvs
- endocervical swab(NAAT Chlamydia and gonorrhea)
- cbc, crp
- ultrasound
Indications for inpatient management of PID(5)
- fever >38
- tubo-ovarian abscess
- suspicion of ectopic or appendicitis
- failed outpatient management
- inability to tolerate oral antibiotics
Outpatient antibiotics regime for PID
- Ceftriaxone 1g IM stat and metronidazole 400mg po bd + doxycyline 100mg po bd x 14 days
Inpatient antibiotic regime PID
- clindamycin 900mg iv tds + gentamicin 2mg/kg loading then 1.5mg/kg tds
Up to 24hrs of clinical improvement
Then
- doxycycline 100mg po bd and metronidazole 400mg po bd x 14days
Reproductive complications of PID
Infertility following 1 mild case : 0.6%
Two episodes 20%
Treatment in pregnancy (rare)
- rocephin
- azithromycin
- metronidazole
What are the diagnostic test for chlamydia
- NAAT of cervical/ vulvovaginal swab 90-95% sensitive
- cell culture 60-80% sensitive 100% specific, expensive
What is the clinical presentation of chlamydia
Women
70% asymptomatic
PCB/IMB
Prudent vaginal/cervical discharge
Contact cervical bleeding
Dyspareunia
Dysuria
Pelvic pain
What is the risk of PID with chlamydia
10-40%
What is the treatment for chlamydia
-Doxycycline 100mg po bd x 7 days
Or
- azithromycin 1g po stat
No need for test of cure
>95% cure
What is the rate of infertility following PID
1 episode 0.6%
2 episodes 21%
What is the treatment course of a TOA
Intravenous antibiotics until clinically improved and then switch to oral to complete 14days
What percentage of patients with a TOA are nulliparous
60%
