Pelvic inflammatory disease

Question 1

What is PID?

Answer 1

It is a polymicrobial infection of upper genital tract and pelvis due to either sexually acquired pathogens and/or endogenous flora following mechanical disruption of normal cervical barrier - e.g pregnancy termination, delivery, surgery, IUD insertion.

Question 2

What signs of PID would I examine for? What investigations should be ordered?

Answer 2

1) Signs of sepsis or septic shock - fever, tachycardia, hypotension
2) Abdominal tenderness, guarding, peritonism
3) Discharge from cervix, cervical motion tenderness, adnexal mass
Take endocervical swab to send for chlamydia PCR and gonorrhoea PCR and culture

Question 3

What is the treatment for sexually acquired PID? Is treatment commenced empirically?

Answer 3

Early empirical tx is recommended to reduce tubal damage. Broad-spectrum abx cover chlamydia, gonorrhoea and mixed vaginal flora:
Mild-moderate:
ceftriaxone
azithromycin
metronidazole
2nd dose azithro 1 week later OR doxycycline
Severe - give IV of the three, then switch to oral metronidazole and doxycycline to complete min 2 weeks tx.

Question 4

What else is key for mx of sexually acquired PID?

Answer 4

1) Notifiable disease to public health

2) Contact tracing and treatment of partner (azithromycin for chlamydia, ceftriaxone for gonorrhoea