PELVIC INFLAMMATORY DISEASE

Question 1

What is pelvic inflammatory disease?

Answer 1

An infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis.

Question 2

What are the most common organisms responsible for pelvic inflammatory disease?

Answer 2

Chlamydia trachomatis
Neisseria gonorrhea
Mycoplasma genitalium

Question 3

What is the organism that is the most common cause of pelvic inflammatory disease in the UK?

Answer 3

Chlamydia trachomatis

Question 4

Pelvic inflammatory disease is not always a primary infection. What other sites or types of infection might lead to pelvic inflammatory disease?

Answer 4

Appendicitis

Tuberculosis

Question 5

What are the risk factors for the development of pelvic inflammatory disease?

Answer 5

Age under 25

Marital status: single

Sexual history: multiple sexual partners

Medical history: past history of STI or PID
recent instrumentation of uterus (e.g. termination)

Use of intrauterine contraceptive device, especially insertion within 3 weeks

Question 6

What are some of the common symptoms associated with pelvic inflammatory disease, which you must ask about in a history?

Answer 6

Pelvic or lower abdominal pain usually bilateral
Deep dyspareunia
Dysmenorrhoea
Abnormal or increased vaginal discharge
Fever

Question 7

What percentage of people with pelvic inflammatory disease caused by chlamydia are asymptomatic?

Answer 7

80%

Question 8

What symptoms of pelvic inflammatory disease might make you suspect chlamydia as the causative organism?

Answer 8

Post-coital or intermenstrual bleeding

Lower abdominal pain

Purulent vaginal discharge

Dysuria

Question 9

What percentage of people with pelvic inflammatory disease caused by gonorrhoea are asymptomatic?

Answer 9

50%

Question 10

What symptoms of pelvic inflammatory disease might make you suspect gonorrhoea as the causative organism?

Answer 10

Increased or altered vaginal discharge

Lower abdominal pain

Dysuria

Question 11

What percentage of people with pelvic inflammatory disease caused by anaerobes such as mycoplasma are asymptomatic?

Answer 11

50%

Question 12

What symptoms of pelvic inflammatory disease might make you suspect anaerobes such as mycoplasma as the causative organism?

Answer 12

Offensive fishy-smelling discharge

Question 13

What investigations should be done with someone in whom you suspect pelvic inflammatory disease?

Answer 13

FBC
CRP
ESR
Blood cultures

Swabs - low and high vaginal, endocervical, urethral. These are now examined using nucleic acid amplification tests (NAATs) rather than immuno-assays.

Mid stream urine sample

Pregnancy test (urinary beta-hCG)

Ultrasound to rule out complications

Question 14

What are the short term complications of pelvic inflammatory disease?

Answer 14

Pelvic abscess formation

Septicaemia

Septic shock

Question 15

What are the long term complications of pelvic inflammatory disease?

Answer 15

Infertility

Increased likelihood of ectopic pregnancy

Chronic pelvic pain

Dyspareunia

Menstrual disturbances

Psychological effects

Fitz-Hugh-Curtis syndrome

Question 16

What are the features of Fitz-Hugh-Curtis syndrome, a rare complication of pelvic inflammatory disease?

Answer 16

Perihepatitis (inflammation of the liver capsule) leading to adhesions

Right upper quadrant abdominal pain

Question 17

What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by chlamydia? Try to include dose.

Answer 17

Chlamydia is a gram negative bacteria

Doxycycline 100 mg bd for 7 days
or
Azithromycin 1g stat

Question 18

What would you give a pregnant lady who is found to have pelvic inflammatory disease caused by chlamydia?

Answer 18

Erythromycin 500 mg bd

Question 19

What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by gonorrhoea? Try to include dose.

Answer 19

Ceftriaxone 250 mg IM stat
or
Cefixime 400 mg PO stat
or
Spectinomycin 2 g IM stat
or
Ciprofloxacin 500 mg PO stat

Question 20

What antibiotic therapy should be given for someone with pelvic inflammatory disease caused by anaerobes such as mycoplasma and gardnerella? Try to include dose.

Answer 20

Metronidazole 400 mg bd for 7 days

Question 21

What might you find on examination that would indicate that the patient was suffering from pelvic inflammatory disease?

Answer 21

Tachycardia
Raised temperature
Abdominal tenderness
Purulent vaginal discharge
Cervical motion tenderness
Adnexal (area next to uterus) tenderness or swelling

Question 22

What is the microorganism responsible for causing syphilis?

Answer 22

Treponema pallidum

Question 23

What antibiotic therapy should be given for someone with syphilis?

Answer 23

First line: benzylpenicillin G given IM

Alternatives: doxycycline (not used in pregnancy)

Question 24

What is the Jarisch-Herxheimer reaction?

Answer 24

A reaction sometimes seen following treatment of syphilis. It is thought to be due to the release of endotoxins following bacterial death.

Question 25

What are the clinical features of the Jarisch-Herxheimer reaction to antibiotic therapy to treat syphilis?

Answer 25

Fever, rash, tachycardia after first dose of antibiotic.

Typically occurs within a few hours of treatment.