Pelvic Inflammatory Disease Flashcards
What is pelvic inflammatory disease (PID)?
Inflammation and infection of the organs of the pelvis caused by infection spreading up through the cervix.
What are two significant complications of PID?
- Tubal infertility
- Chronic pelvic pain
What is endometritis?
Inflammation of the endometrium.
What is salpingitis?
Inflammation of the fallopian tubes.
What is oophoritis?
Inflammation of the ovaries.
What is parametritis?
Inflammation of the parametrium (connective tissue around the uterus).
What is peritonitis?
Inflammation of the peritoneal membrane.
What is the most common cause of PID?
Sexually transmitted pelvic infections, primarily:
* Neisseria gonorrhoeae
* Chlamydia trachomatis
* Mycoplasma genitalium
What are less common causes of PID?
- Gardnerella vaginalis (associated with BV)
- Haemophilus influenzae
- Escherichia coli (associated with UTI)
What are common symptoms of PID?
- Pelvic or lower abdominal pain
- Abnormal vaginal discharge
- Abnormal bleeding (intermenstrual, post-coital)
- Pain during sex (dyspareunia)
- Fever
- Dysuria
What examination findings suggest PID?
- Pelvic tenderness
- Cervical motion tenderness (cervical excitation)
- Inflamed cervix (cervicitis)
- Purulent discharge
What investigations are used for diagnosing PID?
- NAAT swabs for gonorrhea, chlamydia, mycoplasma genitalium
- High vaginal swabs for bacterial vaginosis, candidiasis, trichomonas
- HIV test
- Syphilis test
- Pregnancy test
- Inflammatory markers (CRP, ESR - raised in PID)
What is the management protocol for PID?
- Refer to genitourinary medicine (GUM)
- Contact tracing
- BASSH guidelines for treatment regimens, may include:
- Ceftriaxone
- Doxycycline
- Metronidazole
What are some complications of PID?
- Sepsis
- Abscess
- Infertility
- Chronic pelvic pain
- Ectopic pregnancy
- Fitz-Hugh-Curtis syndrome
What is Fitz-Hugh-Curtis syndrome?
A complication of PID caused by inflammation of the liver capsule (Glisson’s capsule) leading to adhesions between the liver and peritoneum.
How does Fitz-Hugh-Curtis syndrome present?
- Right upper quadrant pain that can refer to shoulder tip.
What procedure is used to visualize and treat adhesions in Fitz-Hugh-Curtis syndrome?
Laparoscopy, specifically via adhesiolysis.
Intramuscular ceftriaxone in a clinic with 14 days of oral doxycycline and metronidazole - first line treatment for what condition?
Pelvic inflammatory disease
