Pelvic Inflammatory Disease

Question 1

Definition of PID?

Answer 1

• Is an inflammation or infection of the organs of the pelvis, caused by infection spreading through the cervix.

Question 2

What are the affected organs ?

Answer 2

• Endometritis
• Salpingitis
• Oophoritis (inflammation of the ovary)
• Parametritis (inflammation of parametrium)
• Peritonitis (inflammation of the peritoneal membrane)

Question 3

Causes?

Answer 3

• Most cases of pelvic inflammatory disease are caused by one of the sexually transmitted pelvic infections:

• Neisseria Gonorrhoeae (tends to produce more severe PID)
• Chlamydia trachomatis
• Mycoplasma genitalium

• Pelvic inflammatory disease can less commonly be caused by non-sexually transmitted infections, such as:

• Gardnerella vaginalis (associated with bacterial vaginosis)
• Haemophilus influenzae (a bacteria often associated with respiratory infections)
• Escherichia coli (an enteric bacteria commonly associated with urinary tract infections)

Question 4

Clinical presentation?

Answer 4

• Pelvic or lower abdomen pain
• Abnormal vaginal discharge
• Abnormal bleeding
• Dyspareunia (pain during sex)
• Dysuria (pain urinating)
• Fever

Question 5

Risk factors?

Answer 5

• Previous PID
• Not using barrier contraception
• Multiple sex partner
• Younger age
• IUD

Question 6

Examation findings?

Answer 6

• Pelvic tenderness
• Cervical motion tenderness
• Inflamed cervix (cervicitis)
• Purulent discharge

Question 7

Investigations?

Answer 7

• Patients with pelvic inflammatory disease should have testing for causative organisms and other sexually transmitted infections:
- NAAT swabs (Nuclear Acid Amplification Test) for Gonorrehoea and Chlamydia
- NAAT swabs for Mycoplasma genitalium if available
- HIV test
- Syphilis test
- Pregnancy test should be performed on sexually active women presenting with lower abdominal pain to exclude ECTOPIC PREGNANCY
- Inflammatory markers (CRP&ESR) are raised in PID and can help support the diagnosis
- A high vaginal swab could be used to look for bacterial vaginosis, candidiasis trichomoniasis
🚩 Absence of pus cells in microscopic is useful to exclude PID

Question 8

Complications?

Answer 8

• Sepsis
• Abscess
• Infertility
• Chronic pelvic pain
• Ectopic pregnancy

Question 9

Management?

Answer 9

• Antibiotics are started before swab results are obtained, to avoid further complications.
  • A single dose of intramuscular ceftriaxone 1g (to cover Gonorrhoea)
• Doxycycline 100mg twice daily for 14days (to cover chlamydia and mycoplasma genitalium)
• Metronidazole 400mg twice daily for 14days (to cover anaerobes such as Gardnerella vaginalis)
• Ceftriaxone and doxycycline will cover many other bacteria, including H. influenzae and E. coli.