Pelvic Inflammatory Disease

Question 1

What is pelvic inflammatory disease?

Answer 1

Infection of the upper genital tract

Question 2

What are causes of PID?

Answer 2

Usually from ascending infection from the endocervix: STIs, uterine instrumentation, postpartum
Can ascend from other infected organs (e.g. appendicitis)
25% due to chlamydia and gonorrhoea

Question 3

What is the most common causative organism in PID? Others?

Answer 3

Clamydia trachomatis
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

Question 4

What arrest factors for PID? Protective factors?

Answer 4

Age < 25
Previous hx of STI
New or multiple sexual partners

Protective:
Use of barrier contraception
Mirena IUS
COCP

Question 5

What are clinical features of PID?

Answer 5

Lower abdominal pain
- uni or bilateral, constant or intermittent
Deep dyspareunia
Vaginal discharge
Intermenstrual bleeding
Postcoital bleeding
Dysmenorrhoea
Fever

Cervical motion tenderness (cervical excitation) with/without adnexal tenderness

Question 6

What investigations in PID?

Answer 6

Vulvovaginal and endocervical swabs for chlamydia and gonorrhoea
MC&S

Check FBC for elevated WCC
CRP
Blood cultures if sepsis
TVS if turbo-ovarian abscess suspected

Question 7

What is management for PID?

Answer 7

Prompt treatment and contact-tracing minimises complications
Treat with empirical abx
Admit for IV abx if severe or sepsis or fail to respond

Question 8

What is outpatient treatment for PID

Answer 8

Ceftriaxone IM or azithromycin PO
\+
Doxycycline PO
\+
Metronidazole PO

Question 9

What is inpatient treatment for PID?

Answer 9

Ceftriaxone IV
+
Doxycycline IV

Followed by
Oral Doxycycline
+ Oral metronidazole

Question 10

What is chronic PID?

Answer 10

Unresolved or inadequately treated infection leads to fibrosis so adhesions develop between pelvic organs
Tubes may be distended with pus or fluid
-
Pelvic pain, menorrhagia, secondary dysmenorrhoea, discharge and deep dyspareunia

Question 11

What are complications of PID?

Answer 11

Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome (liver capsule inflammation with perihepatic adhesions)
Recurrent PID
Ectopic pregnancy
Subfertility from tubal blockage
Chronic pelvic pain

Question 12

What is Fitz Hugh Curtis Syndrome?

Answer 12

A complication of PID where the infection tracks up to the liver from the pelvis, causing right upper quadrant pain and perihepatitis. Chronically this can result in thin adhesions between the liver capsule and the abdominal wall. Fitz-Hugh-Curtis syndrome is most associated with Neisseria gonorrhoeae but may be seen in Chlamydia trachomatis.