Pelvic Inflammatory Disease

Question 1

What is pelvic inflammatory disease?

Answer 1

arises when an infection spreads from the vagina to the cervix, and subsequently to the upper genital tract.

Question 2

What is the aetiology of PID?

Answer 2

The primary pathogens are Chlamydia trachomatis and Neisseria gonorrhoeae, though often, no pathogen can be isolated

Question 3

What are signs and symptoms?

Answer 3

Bilateral abdominal pain
Vaginal discharge
Post-coital bleeding
Adnexal tenderness
Cervical motion tenderness upon bi-manual examination
Fever

Question 4

What is Fitz-Hugh-Curtis syndrome?

Answer 4

Fitz-Hugh-Curtis syndrome occurs when adhesions form between the anterior liver capsule and the anterior abdominal wall or diaphragm in the context of PID. Despite this, liver function tests are usually normal. An abdominal ultrasound should be performed to rule out the presence of stones. A definitive diagnosis and treatment typically require laparoscopy and administration of antibiotics.

Question 5

What are 5 differentials to consider?

Answer 5

Appendicitis: Presents with right lower quadrant abdominal pain, fever, nausea, and vomiting.
Ectopic Pregnancy: Symptoms may include unilateral lower abdominal pain and vaginal bleeding. A positive pregnancy test is a key distinguishing factor.
Endometriosis: Chronic pelvic pain, dysmenorrhea, and dyspareunia are common. Pain typically worsens during menstruation.
Ovarian Cyst: Symptoms can include unilateral lower abdominal pain, bloating, and a palpable mass on examination.
Urinary Tract Infection: Symptoms usually include dysuria, frequency, urgency, suprapubic pain, and possible fever.

Question 6

What investigations are carried out for PID?

Answer 6

Pelvic examination
Pregnancy test
Swabs for gonorrhoea and chlamydia
Blood tests
Transvaginal ultrasound

Question 7

How is PID treated?

Answer 7

In outpatients with combo of Abs:
Ceftriaxone (given intramuscularly) + doxycycline + metronidazole
Ofloxacin + metronidazole

Analgesia may be required with review 4 weeks later

empirical treatment for PID is often initiated in sexually active young women presenting with bilateral lower abdominal pain and adnexal tenderness due to the substantial number of women with PID that remain undiagnosed.

Question 8

What are 3 complications of PID?

Answer 8

Chronic pelvic pain (in around 40% of cases)
Infertility (approximately 15%)
Ectopic pregnancy (about 1%)