Pelvic Inflammatory Disease Flashcards
What is pelvic inflammatory disease
It is inflammation of the upper female genital tract and supporting structures
Uterus oviducts ovaries and the ligaments supporting them
What is the most common cause
Infection
How does infection cause PID
Infection can start at the cervix and ascend or it can spread from other organs such as the appendix
Most common organisms that cause PID
Chlamydia trachmatis
Neisseria gonorrhoea
Risk factors for PID
Same as STIS Past hx STI Early onset of first intercourse inc frequency of intercourse /partners Black race Young age
Complications of PID
Short term Abscess Peri hepatitis - fits-Hugh-Curtis syndrome right UQ pain Long term Tubal factor infertility Ectopic pregnancy Chronic pelvic pain Psycho sexual problems
Why is it difficult to diagnose
Due to a range of varying presentation and severity
What are the clinical features of PID
Symptoms
- lower abdo pain
- deep dyspareunia
- abnormal vaginal bleeding, inc post coital, inter menstrual, and menorrhagia
- secondary dysmenorrhea
- abnormal vaginal or cervical discharge
Signs
- lower abdo tenderness, usually bilateral
-Adenexal tenderness
- cervical motion tenderness
- fever >38
What supports the diagnosis of PID
But doesn’t mean PID isn’t there
STI positive for chlamydia, gonorrhoea, mycobacterium genitalium
Raised ESR CRP
Absence of endocervical or vaginal pus cells has a good negative predictive value but is non-specific
Differential diagnosis
Of PID
Ectopic pregnancy Acute appendicitis Endometriosis Ovarian cyst torsion or rupture UTI Functional pain
Treatment
Broad spectrum ab
Investigation
ESR CRP
Pregnancy
STI and hiv
Laparoscopy
Management of PID
Con - prevention, education, and counselling, screen and tx partners, sex avoidance till clear, Med - outpatient IM Ceftriaxone 1000mg single dose + oral doxycycline 10mg + oral metronidazole 400mg BC 14days Inpatient IV ceftriaxine , doxycycline, Oral dox and oral metronidazole Etc Surg - may want abscess drain May want adhesion separation
