Pelvic Inflammatory Disease Flashcards
How does the cervix prevent infection?
Mucus plug
Columnar Epithelium susceptible to?
Infection with STIs such as chlamydia or gonorrhoea
Nabovium Follicles
Squamous cells over mucus producing cells. Forming white, hard parts
Postcoital Bleeding
Bleeding after sex
PID pathogenesis
Infection goes up from the cervix. Uncomplicated infection becomes complicated. Infection of the female genital tract - endometritis, salobingitis, tubo-ovarian absess
What infections cause PID
Chlamydia Trachiominas, Gonorrhoea, Mycoplasma - they can get through the cervical protective mucus due to enzymes present. // Anaerobic organisms don’t have the same enzymes and so require a breakdown in the mucus plug
Fallopian tube damage due PID
Delayed hypersensitive reaction. Irreversible.
Risk of PID
IUD / Sexual contact (unprotected sex, multiple sexual partners / young people / previous PID (behavioural, contacts aren’t treated correctly
Symptoms of PID
Lower abdopain / deep dysparunia / abnormal vaginal bleeding secondary to cerci it’s or endometritis (post coital, inter menstrual, menorrhagia) / Abnormal Vaginal discharge
Examination
Lower Abdo pain / RIF (right paragutic gutter - infection can track up to the liver) / Adnexal ,ass suggesting tubo ovarian absess / Pelvic examination (purulent cervical discharge, cervical motion tenderness, adenexal tenderness) / peritonitis mimicking an acute surgical abdomen
Differential Diagnosis
Appendicitis / Ectopic pregnancy (permanency test must be done!) / UTI / Ovarian torsion / Endometriosis (cyclical bleeding) / IBS
Diagnosis
Mainly clinical / STI screen (vaginal wall sample to look for vaginal commensals, Volvo-vaginal acid application test for both chlamydia and gonorrhoea / Temperature / ESR and CRP / USS
Treatment
Chalmydia - Ofloxacin (400mg bd 2 weeks) / LOOK UP
admitting to hospital
Systemically unwell / Pain / IV antibiotic (vomiting) / Pregnancy (>20 weeks) / Diagnostic uncertainty
IUD Removal
Should be remov in severe disease / Better recovery rate when the coil is removed
Complications
Ectopic pregnancy increases (due to smaller tube and less likely the fertilised egg can’t get through) /Infertility due to tubal occlusion, increases with each episode of PID / Chronic pelvic pain - due to adhesions, 18% higher after a single episode, 8x increase in rate of hysterectomy / Endometriosis 6x more common due to damaged epithelium
Fitz-Hugh-Curtis syndrome
Right upper quadrant pain / 10-20 % women with PID / right parabolic gutter …MORE
Chlamydia screening programme
18-34 yo / Decrease in PID nationally…MORE
Likely good of infertility after 2 episodes after PID
20%
Appropriate treatment for PID
Metronidazole, Ofolaxin (LOOK THIS Up)
Having a coil increases risk of PID?
No
HIV positive gives a worse prognosis
False
Male partner of a women with PID only needs treating if an infection is identify once he’s screened
False - empirical treatment is required
Risk incident of PID of infertility on first encounter
10 % risk of infertility
