Pelvic Inflammatory Disease

Question 1

What is endometritis?

Answer 1

Inflammation and infection of the endometrium

Question 2

Pathophysiology of PID?

Answer 2

Ascending infection from the endocervix and vagina

Causes inflammation which causes damage to tubal epithelium and adhesions form

Question 3

Complications of PID?

Answer 3

Ectopic pregnancy
Infertility
Chronic pelvic pain
Fitz-Hugh-Curtis syndrome - right upper quadrant pain and peri-hepatitis following chlamydial PID

Question 4

Aetiology of PID?

Answer 4

Often polymicrobial
STIs - C trachomatis, N gonorrhoeae
Others - Gardenerella vaginalis, Mycoplasma, anaerobes

Question 5

Epidemiology of PID?

Answer 5

Sexually active women, peak from 20-30yrs

Incidence rate in primary care approx 280/100,000 person-years

Question 6

Risk factors for PID?

Answer 6

Young age
No barrier contraception 
Multiple sexual partners
Low socko-economic class
Intra-uterine contraceptive device (within 1 week of implantation)

Question 7

History for PID?

Answer 7

Pyrexia
Pain
-lower abdomen
-deep dyspareunia
Abnormal vaginal bleeding 
Abnormal vaginal/cervical discharge
Sexual history and prior STI
Contraceptive history

Question 8

Examination for PID?

Answer 8

Fever >38*C
Lower abdominal tenderness which is usually bilateral
Bimanual exam - adnexal tenderness and cervical motion tenderness
Speculum exam - purulent cervical discharge and cervicitis

Question 9

Differential diagnoses of PID?

Answer 9

Gynaecological

• ectopic pregnancy
• endometriosis
• complications of an ovarian cyst

GI

• IBS
• acute appendicitis

Renal
-UTI

Other
-functional pain (pain of unknown physical origin)

Question 10

Investigations for PID?

Answer 10

Endocervical swab for gonorrhoea and chlamydia
High vaginal swab for bacterial vaginosis, trichomonas vaginalis, Candida

Positive swabs support diagnosis
Negative swabs don’t exclude it

Question 11

Management of PID?

Answer 11

Analgesia
Antibiotics
-mild/moderate disease: oral
-severe: IV

Admit to hospital if tubo-ovarian abscess, PID in pregnancy, lack of response to oral therapy

Question 12

Outpatient antibiotics for PID?

Answer 12

IM ceftriaxone
PO doxycycline
PO metronidazole

Question 13

Inpatient treatment of PID?

Answer 13

IV ceftriaxone
IV/PO doxycycline
IV metronidazole
PO doxycycline
PO metronidazole
Continue for 14 days

Question 14

Surgical management of PID?

Answer 14

Laparoscopy/laparotomy if there is no response to therapy, severe or an abscess
Ultrasound-guided aspiration of pelvic fluids is less invasive

Question 15

What is Fitz-Hugh Curtis syndrome?

Answer 15

RUQ pain and peri-hepatitis - follows chlamydial PID in 10-15% of patients

Question 16

What increases the risk of Fitz-Hugh Curtis syndrome?

Answer 16

Repeated episodes of PID

Question 17

What is pelvic inflammatory disease?

Answer 17

The result of infection ascending from the endocervix, causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis