Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

infection of the upper genital tract

Question 2

What are the causes of PID?

Answer 2

usually ascending infection from the endocervix:
STIs (gonorrhoea and chlamydia), uterine instrumentation (IUD, TOP_
post partum
Infected organs e.g. appendicitis

Question 3

What increases the risk of getting PID?

Answer 3

<25 yrs
prev hx of STIs
new/multiple sexual partners

Question 4

What are protective factors for PID?

Answer 4

barrier contraception
IUD
COCP

Question 5

What are the sx of PID?

Answer 5

Lower abdomen pain 
deep dyspareunia
vaginal discharge
IMB/PCB
Dysmenorrhoea
Fever

Question 6

What can be found on examination in PID?

Answer 6

Vaginal discharge

cervical motion tenderness

Question 7

What are the investigations for pID?

Answer 7

1. Endocervical swabs for chlamydia and gonococcus
2. Blood cultures if fever
3. WBC and CRP may be raised
4. Pelvic US helps to exclude abscess and ovarian cyst
5. Laparoscopy with fimbrial biopsy and culture is gold standard although not commonly performed

Question 8

What is the treatment for PID?

Answer 8

1. Analgesics
2. Parental cephalosporin - ceftriaxone + doxycycline + metronidazole
3. IV therapy if febrile
4. Pelvic abscess may require drainage

Question 9

What can be given in penicillin allergies?

Answer 9

azithromycin + metronidazole + doxycycline

Question 10

What are the complications of PID?

Answer 10

Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome (liver capsulen inflammation w perihepatic adhesions)
recurrent PID
Ectopics
Subfertility from tubal blockage

Question 11

What causes chronic PID?

Answer 11

Result of non-or inadequate treatment of acute PID

Question 12

What are the consequences of chronic PID?

Answer 12

Dense pelvic adhesions and fallopian tubes may be obstructed and dilated with fluid or pus (pyosalpinx)

Question 13

What is found on examination of chronic pID?

Answer 13

→ Features like endometriosis: abdo and adnexal tenderness and fixed retroverted uterus

Question 14

What investigations are performed for chronic PID?

Answer 14

TVS - fluid collections in Fallopian tubes and surrounding adhesions
Laparoscopy
Cultures - often negative

Question 15

What is the treatment of chronic PID?

Answer 15

¬ Analgesics and antibiotics if evidence of active infection
¬ Severe cases sometimes respond to cutting adhesions but sometimes salpingectomy is required