Pelvic inflammatory disease

Question 1

What is pelvic inflammatory disease

Answer 1

General term for infection of the upper female genital tract, including the uterus, Fallopian tubes, and ovaries

Question 2

What are some cause of PID

Answer 2

• Usually results from ascending infection from endocervix:
  
  • Endometritis, salphingitis, tubo-ovarian abscess
  • Chlymydia, gonorrhoea, gardenella, anaerobes

Question 3

What are some symptoms of PID?

Answer 3

• Lower abdominal pain
• Deep dyspareunia
• Dysuria
• Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia)
• Abnormal vaginal discharge (especially if purulent or with an unpleasant odour)

Question 4

What are some signs of PID?

Answer 4

• Onvaginal examination, there may be tenderness of uterus/adnexae or cervical excitation (on bimanual palpation)
• There may be a palpable mass in the lower abdomen, with an abnormal vaginal discharge noted
• In severe cases - fever above 38°C (but may be apyrexial)

Question 5

What are some investigations required in PID?

Answer 5

• Full STI screen
• Urine dipstick +/- MSU to exclude UTI
• Pregnancy test
• Transvaginal US - if severe disease or dignostic uncertainty
• Laparoscopy - indicated only in severe cases where there is diagnostic uncertainty

Question 6

How is PID managed in adults?

Answer 6

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

Question 7

How is PID managed in under 18s or those at risk of gonorrhoea?

Answer 7

ceftriaxone 1G IM, doxycycline 100mg bd x 2 weeks and metronidazole 400mg bd x 2 weeks

Question 8

What are some complications of PID?

Answer 8

Infertility, ectopic pregnancy, abscess formation and chronic pelvic pain