Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

The result of infection ascending from the endocervix, causing endometritis, salpingitis, parmetritis, oophritis, tubo-ovarian abcess and/ or pelvic peritonitis

Question 2

Explain endometritis

Answer 2

Inflammation and infection of the endometrium

Question 3

Explain salpingitis

Answer 3

inflammation of the fallopian tube

Question 4

Outline risk factors for PID

Answer 4

• Higher in urban areas
• Sexually active women
• 20-24 years old
• IUCD contraceptive device increases risk for few weeks
• Alcohol and drug use
• Cigarette smoking

Question 5

Outline pathogens involved in PID

Answer 5

• Gonorrhoea (14% cases) and Chlamydia are main ones

* Garderella, Mycoplasma and anaerobes also implicated

Question 6

Outline the pathophysiology of PID

Answer 6

• ascending infection from the endocervix and vagina
• Inflammation causes adhesions
• Damage to tubal epithelium

Question 7

List the clinical features of PID

Answer 7

• Pyrexia >38C
• Pain –> bilateral lower abdominal tenderness
• Abnormal vaginal/ cervical discharge
• Abnormal vaginal bleeding
• Adnexal tenderness
• Cervical excitation

Question 8

Differential diagnoses

Answer 8

• Ectopic pregnancy
• Endometriosis
• Ovarian Cyst complications
• IBS
• Acute appendicitis
• Pyelonephritis

Question 9

Investigations of PID

Answer 9

• Endocervical swab
• High vaginal swab
• Contact screening

Question 10

Treatment and management of PID

Answer 10

• Analgesia
• Antibiotics (PO/IV): Ceftriaxone + Doxy + Metro
• Laparotomy if no medical improvement

Question 11

Associated risks with PID

Answer 11

• Ectopic pregnancy
• Infertility
• Chronic pelvic pain
• Fitx High Curtis Syndrome (RUQ pain + peri hepatitis)