Pelvic Inflammatory Disease

Question 1

What is the definition of pelvic inflammatory disease?

Answer 1

Infection of upper female genital tract, including the uterus, Fallopian tubes, and ovaries.

Question 2

What causes PID?

Answer 2

Usually ascending infection from endocervix:
- Endometritis, salpingitis, tubo-ovarian abscess
- Chlamydia, gonorrhoea, gardenella, anaerobes

Question 3

What are some symptoms of PID?

Answer 3

Lower abdominal pain
Deep dyspareunia
Dysuria
Abnormal PV bleeding (postcoital, intermenstrual, menorrhagia) or discharge (purulent or odorous)

Question 4

What are some signs of PID?

Answer 4

Tenderness of uterus/adnexae or cervical excitation (on bimanual exam)
May have palpable mass in lower abdomen with abnormal discharge
Fever above 38 degrees (severe cases)

Question 5

What are some investigations of PID?

Answer 5

Full STI screen
Urine dipstick +/- MSU
Pregnancy test
TVUS (severe disease or diagnostic uncertainty)
Laparoscopy (severe disease or diagnostic uncertainty)

Question 6

What is the management of PID?

Answer 6

Metronidazole 400mg bd + ofloxacin 400mg bd (14 days)

If under 18 or high risk of gonorrhoea: ceftriaxone 1G IM, doxycyline 100mg bd x 2 weeks and metronidazole 400mg bd x 2 weeks

Question 7

What are some complications of PID?

Answer 7

Infertility
Ectopic pregnancy
Abscess formation
Chronic pelvic pain