Pelvic Inflammatory Disease Flashcards
How is pelvic inflammatory defined?
Clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures
T/F: A history of gonorrhea or chlamydia infection is not a risk factor for PID
False
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
C) Monogamous Relationship
T/F: Most causes of PID are monomicrobial
False
Most cases of PID are polymicrobial
What are the TWO most common pathogens in PID?
Can you see these pathogens in combination in PID?
N. gonorrhea
C. trachomatis
These are seen in combination in 25-75% of PID patients
What aerobic gram-negative rod can often be a pathogen in PID?
E. coli
Describe the ‘ascending’ pathway of infection in PID?
Cervicitis –> Endometritis –> Salpingitis/oophoritis/TOA –> Peritonitis
Women with PID can be asymptomatic up to __% of the time.
This would be considered ________ (clinical/subclinical) disease
60%
Subclinical Disease
What are two symptoms that may be present in subclinical PID, but the patient doesn’t associate to PID?
Dysuria
Dsyspareunia
Which pathogen is more common in subclinical PID….
N. gonorrhea or C. trachomatis?
C. trachomatis
What are common symptoms in ‘symptomatic PID’?
Lower Abdominal Pain
Pelvic Pain
Vaginal Discharge
What are three common findings on pelvic exam in a patient with PID?
Uterine Tenderness
CMT
Adnexal Tenderness
Severe PID may most likely present with ________ (purulent/non-purulent) vaginal discharge, a _________ (leukocytosis/leukopenia) on CBC, and possibly elevated __________ (inflammatory markers/LFTs)
Purulent Vaginal Discharge
Leukocytosis on CBC
Elevated Inflammatory Markers (CRP, ESR)
What are three sequelae of a single PID episodes?
Ectopic Pregnancy
Infertility
Chronic Pelvic Pain
Patients with three episodes of PID have a __% chance of infertility
50%
What is the MOST SENSITIVE finding on pelvic exam for PID diagnosis?
What other two signs may be present?
Most Sensitive: Acute adnexal tenderness
Other:
Uterine Tenderness
Cervical Motion Tendernss
_____ (WBCs/Nitrates) on a saline wet prep would help diagnosis PID
WBCs
What is Fitz-Hugh-Curtis Syndrome?
A complication of gonococcal or chlamydial salpingitis which is characterized by RUQ pain in associated with acute salpingitis indicating perihepatitis +/- cholecytisis
What ABx should be used for pID treatment
Ceftriaxone PLUS Doxycyclne PLUS Metronidiazole
Tx can be without metronidazole however most literature supports it
What are some criteria for hospitalization for PID?
- Inability to exclude surgical emergencies
- Pregnancy
- Failed management
- Severe illness
- HIV
Should women refrain from sexual activity while completing their pharmacological management for PID?
Yes
Typically ABx therapy is 14 days
T/F: All women who received a diagnosis of acute PID should be tested for HIV, as well as GC and chlamydia, using NAAT
True
Patients being treated for PID should demonstrate improvement within ___ hours.
If they fail to improve, patients most likely require _______ for further investigation
Improve with 72 hours
Failure to improve most likely requires hospitalization
Women should be retested in __ _____ after being diagnosed with gonorrhea/chlamydia
3 months
