Pelvic inflammatory disease

Question 1

Causative organisms

Answer 1

Chlamydia trachomatis (most common)

Neisseria gonorrhoea

Mycoplasma genitalium

Mycoplasma hominis

Question 2

Risk factors

Answer 2

Not using barrier contraception

Multiple sexual partners

Younger age

Existing STIs

Previous PID

Intrauterine device

Question 3

Presentation

Answer 3

Pelvic or lower abdo pain

Abnormal vaginal discharge

Abnormal bleeding (IM or PC)

Pain during sex

Fever

Dysuria

Cervical motion tenderness

Inflamed cervix

Question 4

Investigations

Answer 4

Pregnancy test to exclude ectopic

High vaginal swab

Screen for chlamydia and gonorrhoea (NAAT)

HIV test

Syphilis test

Question 5

Management

Answer 5

Refer to GUM

Single dose of IM ceftriaxone 1g (to cover gonorrhoea)

Doxycycline 100mg BD for 14 days (to cover chlamydia and mycosplama genitalium)

Metronidazole 400mg BD for 14 days (to cover anaerobes)

Question 6

Complications

Answer 6

Sepsis

Abscess

Infertility

Chronic pelvic pain

Ectopic pregnancy

Fitz-Hugh-Curtis syndrome

Question 7

Fitz-Hugh-Curtis syndrome

Answer 7

Inflammation and infection of the liver capsule (Glisson’s capsule)

Leads to adhesions between liver and peritoneum

RUQ pain than can be referred to right shoulder tip if diaphragmatic irritation