Pelvic Inflammatory Disease

Question 1

How is pelvic inflammatory defined?

Answer 1

Clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures

Question 2

T/F: A history of gonorrhea or chlamydia infection is not a risk factor for PID

Answer 2

False

Question 3

Which of the following is not a risk for for PID?

A) Having multiple sexual partners
B) Being an adolescent
C) Monogamous Relationship
D) Having an IUD placed

Answer 3

C) Monogamous Relationship

Question 4

T/F: Most causes of PID are monomicrobial

Answer 4

False

Most cases of PID are polymicrobial

Question 5

What are the TWO most common pathogens in PID?

Can you see these pathogens in combination in PID?

Answer 5

N. gonorrhea
C. trachomatis

These are seen in combination in 25-75% of PID patients

Question 6

What aerobic gram-negative rod can often be a pathogen in PID?

Answer 6

E. coli

Question 7

Describe the ‘ascending’ pathway of infection in PID?

Answer 7

Cervicitis –> Endometritis –> Salpingitis/oophoritis/TOA –> Peritonitis

Question 8

Women with PID can be asymptomatic up to __% of the time.

This would be considered ________ (clinical/subclinical) disease

Answer 8

60%

Subclinical Disease

Question 9

What are two symptoms that may be present in subclinical PID, but the patient doesn’t associate to PID?

Answer 9

Dysuria

Dsyspareunia

Question 10

Which pathogen is more common in subclinical PID….

N. gonorrhea or C. trachomatis?

Answer 10

C. trachomatis

Question 11

What are common symptoms in ‘symptomatic PID’?

Answer 11

Lower Abdominal Pain
Pelvic Pain
Vaginal Discharge

Question 12

What are three common findings on pelvic exam in a patient with PID?

Answer 12

Uterine Tenderness
CMT
Adnexal Tenderness

Question 13

Severe PID may most likely present with ________ (purulent/non-purulent) vaginal discharge, a _________ (leukocytosis/leukopenia) on CBC, and possibly elevated __________ (inflammatory markers/LFTs)

Answer 13

Purulent Vaginal Discharge

Leukocytosis on CBC

Elevated Inflammatory Markers (CRP, ESR)

Question 14

What are three sequelae of a single PID episodes?

Answer 14

Ectopic Pregnancy
Infertility
Chronic Pelvic Pain

Question 15

Patients with three episodes of PID have a __% chance of infertility

Answer 15

50%

Question 16

What is the MOST SENSITIVE finding on pelvic exam for PID diagnosis?

What other two signs may be present?

Answer 16

Most Sensitive: Acute adnexal tenderness

Other:

Uterine Tenderness
Cervical Motion Tendernss

Question 17

_____ (WBCs/Nitrates) on a saline wet prep would help diagnosis PID

Answer 17

WBCs

Question 18

What is Fitz-Hugh-Curtis Syndrome?

Answer 18

A complication of gonococcal or chlamydial salpingitis which is characterized by RUQ pain in associated with acute salpingitis indicating perihepatitis +/- cholecytisis

Question 19

What ABx should be used for pID treatment

Answer 19

Ceftriaxone PLUS Doxycyclne PLUS Metronidiazole

Tx can be without metronidazole however most literature supports it

Question 20

What are some criteria for hospitalization for PID?

Answer 20

1. Inability to exclude surgical emergencies
2. Pregnancy
3. Failed management
4. Severe illness
5. HIV

Question 21

Should women refrain from sexual activity while completing their pharmacological management for PID?

Answer 21

Yes

Typically ABx therapy is 14 days

Question 22

T/F: All women who received a diagnosis of acute PID should be tested for HIV, as well as GC and chlamydia, using NAAT

Answer 22

True

Question 23

Patients being treated for PID should demonstrate improvement within ___ hours.

If they fail to improve, patients most likely require _______ for further investigation

Answer 23

Improve with 72 hours

Failure to improve most likely requires hospitalization

Question 24

Women should be retested in __ _____ after being diagnosed with gonorrhea/chlamydia

Answer 24

3 months

Question 25

All pregnant women should be screen for chlamydia in which trimester?

Answer 25

1st Trimester

Question 26

T/F: All sexually active women older than 25 y.o. with high risk behaviors should be screen for chlamydia

Answer 26

True

Question 27

Male sex partners of women with PID should be examined and treated if they had sexual contact with the patient during the ___ days preceding the patient’s onset of symptoms

Answer 27

60 days

Question 28

T/F: Sex partners should be treated empirically with regimens effective against both C. trachomatis and N. gonorrhoeae, regardless of the apparent etiology of PID or pathogens isolated from the infected woman

Answer 28

True

Question 29

T/F: Gonorrhea and Chalmydia are NOT reportable diseases in every state

Answer 29

False

They are reportable diseases in every state

Question 30

Should the use of condoms be included in patient education for the prevention of PID?

Answer 30

Yes