Pelvic Inflammatory Disease Flashcards
Definition of PID
An ascending infection of the female upper genital tract - may be acute or chronic With a spectrum of disease - endometritis - salpingitis - oophoritis - tubo-ovarian abscess - local/ pelvic and generalised peritonitis
Who gets PID?
- women of reproductive age
- usually sexually transmitted
Definition of secondary PID
- infection from elsewhere in the body spreads to the upper genital structures
Another name for acute PID
Acute salpingo-oophoritis
Definition of chronic PID
- complications of acute PID (adhesions, fibrosis) cause frozen pelvis
- chronic infective process of the pelvis (TB, schisto)
Differentials of PID
- endometriosis
- chronic ectopic pregnancy
- chronic bladder and bowel conditions
Risk factors for PID
- earl sexual debut
- age <25
- promiscuity
- low parity
- previous PID/STI
- concomitant STI
- low SES
- BV
Protective factors for PID
- barrier contraception
- oral contraception
- tubal ligation
- pregnancy
Most common organisms causing PID (primary invaders)
- Chlamydia trachomatis
- Neisseria gonorrhoea
- anaerobes (Gardnerella vaginalis and Mycoplasma hominis)
Common secondary invaders in PID
- E. coli
- peptostroptococcus
- S. Faecalis
- anaerobes
Pathogenesis of PID
- progressive inflammation, sweeling and hyperaemia of fallopian tubes
- causes tubal adhesion
- tubal ostia become occluded
- pelvic peritonitis
- pyosalpinx/ tubo-ovarian abscess
- generalised peritonitis
Symptoms of PID
- lower abdo pain
- offensive discharge
- fever
- urinary frequency/ dysuria
- irregular vaginal bleeding
Signs of PID
- sick-looking patient
- pyrexial, tachycardic
- lower abdo tenderness, pelvic and generalised peritonitis
- mucopurulent vaginal discharge
- cervical excitation tenderness
- uterine tenderness
- bilateral adnexal tenderness
What is Fitz-Hugh-Curtis syndrome?
- PID is complicated by peri-hepatitis
How is PID classified?
The Gainesville system
Stages of the Gainesville system
1: early salpingitis (apyrexial)
2: late salpingitis (pyrexial)
3: pyosalpinx/ tubo-ovarian abscess
4: ruptured tubo-ovarian complex, general peritonitis, septicaemia
5: ARDS
Treatment of stage 1 PID
- hospital admission not usually required
- empiric oral antibiotics/ oral analgesia
Treatment of stage 2 PID
- usually require hospital admission
- empiric oral and IV AB
- often opiate analgesia
Treatment of stage 3 and 4 PID
- hospital admission always
- empiric oral and IV AB
- opiate analgesia
- allow 48 hrs to respond to Rx
- surgery
Indications for admission for PID
- acute PID with signs of local/generalised perinoteal irritation
- temp >38
- nausea and vomiting
- failure to respond to oral therapy
- intolerance to oral medication
- uncertain diagnosis
- HIV
- unreliable to follow-up
Oral AB for PID
- cefixime
- doxycycline
- metronidazole
IV AB for PID
- ampicillin
- gentamycin
- metronidazole
Surgical methods for PID
- laparotomy
- laparoscopy
- US guided drainage of pus
- posterior colpotomy
