Pelvic Inflammatory Disease

Question 1

Pelvic inflammatory disease

Answer 1

An acute ascending polymicrobial infection of the female gynaecological tract

Question 2

Bacteria PID most commonly associated with

Answer 2

STI bacteria: Neisseria gonorrhoeae and Chlamydia trachomatis

Micro-organisms that comprise the vaginal flora (e.g., anaerobes, Gardnerella vaginalis , Haemophilus influenzae , enteric gram-negative rods, and Streptococcus agalactiae )

Question 3

Signs and symptoms of PID

Answer 3

One of the following three makes the diagnosis:
Adnexal tenderness
Uterine tenderness
Cervical motion

Fever, Nausea & Vomiting
Presence of risk factors
Dyspareunia
Dysmenorrhea
Menorrhagia
Dysuria

Question 4

Risk factors of PID

Answer 4

prior infection with chlamydia or gonorrhoea
young age at onset of sexual activity
unprotected sexual intercourse with multiple sexual partners
prior hx of PID
IUD use in first 3 weeks after insertion

Question 5

Investigations to order for PID

Answer 5

WCC: elevated
Vaginal polymorphonuclear leukocytes (PMNs) found on smear
ESR raised
Cultures for Neisseria gonorrhoeae and Chlamydia trachomatis

Question 6

Management of PID mild

Answer 6

1.Ceftriaxone 250 mg IM stat and doxycycline: 100 mg PO BD for 14 days
2. metronidazole 500mg PO BD for 14 days (covers anaerobic)
Contact tracing
Consider removal of IUD

Question 7

Management of PID severe or no response to oral Abx

Answer 7

IV Abx:
cefotetan: 2 g IV every 12 hours
or
cefoxitin: 2 g IV every 6 hours

– AND –

doxycycline: 100 mg orally/intravenously every 12 hours

Switch to oral as patient gets better
Sexual contact tracing
Consider removal of IUD