Pelvic Inflammatory Disease Flashcards
What is PID?
The result of infection ascending from the endocervix, causing endometritis, salpingitis, parametritis, oophoritis, turbo-ovarian abscess and / or pelvic peritonitis.
Describe the pathophysiology of PID
Ascending infection from the endocervix and vagina
Infection causes inflammation
Inflammation causes damage - Thus damaged tibial epithelium so adhesions form.
Some recovery if tubal epithelium does occur.
What is endometritis?
Inflammation and infection of the endometrium
What is salpingitis?
Inflammation of the fallopian tubes
What is a tubo-ovarian abscess?
Tubo-ovarian abscesses (TOA) are one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis.
It consists of an encapsulated or confined ‘pocket of pus’ with defined boundaries that forms during an infection of a fallopian tube and ovary.
What can cause PID?
Chlamydia trachomatis
Neiserria gonorrhoea
(50% = STI)
Gardnerella vaginalis
Mycoplasma hominis
Anaerobes
Actinomycosis
Often polymicrobial
Who most commonly gets PID?
It is underestimated
Sexually active women - 20-30yrs old
Incidence rate = 280 / 100,000py
What are risk factors for PID?
Young age No condoms Multiple sexual partners Low socioeconomic class (as more likely to do these things) IUD
What clinical features do you look for in the history?
Pyrexia Pain -lower abdomen, deep dyspareunia Abnormal vaginal / cervical discharge Abnormal vaginal bleeding Sexual history and prior STIs Contraceptive history
What clinical features do you find on examination of patient with PID?
Fever
Lower abdominal tenderness - usually bilateral
Bimanual examination - adexal tenderness +/- mass, cervical motion tenderness
Speculum examination - lower genital tract infection, purulent cervical discharge, cervicitis
What other things could suspected PPID be?
Gynaecological:
- Ectopic pregnancy
- Endometriosis
- Oarian cyst complications
GI:
- IBS
- Appendicitis
Urinary:
-UTI
Other:
-Functional pain
What investigations do you do for PID?
Urinary and/or serum pregnancy tests
Endocervical and high vaginal swabs -presence of NG/CT suppports diagnosis but absence does not exclude
Blood tests - WBC and CRP
Screening fo other STIs including HIV
Diagnostic laparoscopy is gold standard - also do adhesiolysis (divide adhesions) and drain abscess -But, if normal case, rarely do this in practise
What are you most likely to find in a laparoscopy in women with suspected PID?
Salpingitis / PID - 65% Normal - 22% Appendicits - 3% Endometriosis - 2% Bleeding corpus luteum - 2% Ectopic pregnancy - 2% Other - 4%
How do you manage PID?
Low threshold for empirical treatment - delayed treatment increases long term sequalae
Symptomatic management with analgesia and rest
Management of sepsis
Severe disease requires IV antibiotics and admission for observation and possible surgical intervention.
- Pyrexia .38, signs of tubo-ovarian abscess, signs of pelvic peritonitis
- No response to oral therapy
- Increased risk of longterm sequelae
Contact tracing essential for partners, and full screen for women
How do you treat PID as an outpatient?
Ceftriaxone and either doxycycline or metronidazole
