Pelvic inflammatory disease

Question 1

What causes PID?

Answer 1

Chronic inflammation of the pelvic structures can be caused by infection to the pelvis e.g. chlamydia and gonorrhoea
Endometriosis can also lead to PID

Question 2

What symptoms are experienced in PID?

Answer 2

Can be none or can be severe 
Pelvic pain 
Can have fever 
Cervical motion tenderness 
Adnexal tenderness
Lower abdo pain and tenderness on exam
Change in discharge 
Deep dyspareunia 
Irregular bleeding

Question 3

What are some complications of PID?

Answer 3

Sub-Fertility (tubal)
Chronic pain
Increases risk of ectopic pregnancy

Question 4

If a woman with know history of pelvic pain / PID started experiencing pain in the RUQ what might you suspect?

Answer 4

FITZ-HUGH CURTIS SYNDROME

- Peri-hepatic inflammation and scarring

Question 5

How should PID be treated?

Answer 5

Use antibiotics to clear any underlying infection - always treat as if it is an STI (most likely)
-single dose of IM CEFTRIAXONE 1mg
+DOXYCYCLINE and METRONIDAZOLE for 14 DAYS

Use analgesics to cover pain
Can consider explorative laparoscopy to rule out other causes

Question 6

How should we investigate PID?

Answer 6

NAAT 
Serology to test for syphilis and HIV 
Urine dip and MSU
Temp
Endocervical swab for gonorrhoea 
BLOODS: FBC, U&E, LFTs
Pregnancy test 
?Microscopy of discharge 
USS or ExLap

Question 7

What information should you give to a woman with PID?

Answer 7

25% caused by STI which is why we’re investigating
Most women will go on to get pregnant and have a normal pregnancy
No sex until her and her partner have been fully investigated

Question 8

What is endometriosis?

Answer 8

When there is ectopic endometrial tissue found elsewhere in the body (in the myometrium=adenomyosis), can be in tubes, ovaries or in the abdomen

Question 9

What are some common symptoms experienced by women with endometriosis?

Answer 9

Menorrhagia
Dysmenorrhoea (some pain before menstruation then during menstruation it gets worse and then disappears after)
Dyspareunia - deep and might last for several hours after sex
May have anal/rectal sx
Bloating/constipation (cyclical pattern)
History of CS/TOP

Question 10

Is there any associations between endometriosis and reduced fertility?

Answer 10

Yes - thought to be due to the formation of adhesions

Question 11

How should we investigate a woman who has suspected endometriosis?

Answer 11

ExLAP - GOLD STANDARD
O/E: tenderness, fixed uterus (not mobile)
USS

***degree of endometriosis i.e. how much ectopic tissue there is does not appear to tally with severity of symptoms

Question 12

How should we manage endometriosis?

Answer 12

NSAIDs
Oral contraceptive inhibit ovulation and thus proliferation of endometrium which helps ease symptoms
Mirena IUS
GnRH analogues (ovarian suppression)
Danazol
SURGERY (ablation, resection of lesions, laparoscopy oophorectomy, Laparoscopy uterine nerve ablation, hysterectomy)