Pelvic Inflammatory Disease

Question 1

Define PID (5)

Answer 1

The result of an infection ascending from the endocervix causing endometritis, salpingitis, parametritis, oophoritis, turbo-ovarian abscesses, and pelvic peritonitis. Infection > inflammation > damage > adhesions > reduced fertility.

Question 2

Define endometritis (2)

Answer 2

Inflammation of the endometrial lining, can be acute or chronic.

Question 3

Define salpingitis (4)

Answer 3

Inflammation of the Fallopian tube. Exudates cause the tube to fill with pus, causing abscesses, adhesions and obstruction which interferes with the ciliated epithelium.

Question 4

Describe the causes of PID. (4)

Answer 4

Neisseria gonorrhoea
Chlamydia trachomatis
Bacterial vaginosis
IUD - insertion or removal increases PID risk if already have STI.

Question 5

Describe the risk factors for PID (5)

Answer 5

Same as for chlamydia and gonorrhoea - low social class, no condoms, multiple sexual partners, younger.
Also IUD

Question 6

Describe the symptoms of PID (6)

Answer 6

Pyrexia
Lower abdominal pain
Deep dyspareuria 
Abnormal discharge
Abnormal bleeding
Prior STIs

Question 7

Describe the signs of PID. (3)

Answer 7

Pyrexia
Bilateral lower abdominal tenderness
Cervical tenderness or inflammation

Question 8

Describe other differentials that could cause similar symptoms to PID. (7)

Answer 8

Gynaecological - ectopic pregnancy, endometriosis, ovarian cysts.
GI - IBS, appendicitis
Urinary - UTI
Other - normal pelvic pain eg period cramps.

Question 9

Describe the investigations that would be undertaken if you suspected PID. (4)

Answer 9

Pregnancy test
Endocervical and high vaginal swabs - STI absence doesn’t exclude PID
Blood tests - WCC, CRP, HIV, syphilis
Diagnostic laparoscopy is gold standard

Question 10

Describe the management of PID (4)

Answer 10

Begin ceftriaxone for STIs
Analgesia and rest
Management of sepsis if necessary
Admit for abscess drainage or adhesiolysis if needed.

Question 11

Describe complications of PID (5)

Answer 11

Ectopic pregnancy risk increased
Infertility
Chronic pelvis pain
Fitz-Hugh-Curtis syndrome - RUQ pain and peri-hepatitis following chlamydia PID - uterus > Fallopian tube > peritoneal space > liver.
Reiter syndrome - disseminated chlamydia infection.