Pelvic inflammatory disease Flashcards
1
Q
Pelvic inflammatory disease
Causative organisms
A
- Chlamydia trachomatis - the most common cause
- Neisseria gonorrhoeae
- Mycoplasma genitalium
- Mycoplasma hominis
2
Q
Pelvic inflammatory disease
Features
A
- lower abdominal pain
- fever
- deep dyspareunia
- dysuria and menstrual irregularities may occur
- vaginal or cervical discharge
- cervical excitation
- perihepatitis (Fitz-Hugh Curtis Syndrome) occurs in around 10% of cases. It is characterised by right upper quadrant pain and may be confused with cholecystitis
3
Q
Pelvic inflammatory disease
Investigations/Management
A
Investigation:
screen for Chlamydia and Gonorrhoe
Management:
- due to the difficulty in making an accurate diagnosis, and the potential complications of untreated PID, consensus guidelines recommend having a low threshold for treatment
- oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole
- RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ‘ Removal of the IUD should be considered and may be associated with better short term clinical outcomes’
4
Q
Pelvic inflammatory disease
Complications
A
- infertility - the risk may be as high as 10-20% after a single episode
- chronic pelvic pain
- ectopic pregnancy
