Pelvic Inflammatory Disease Flashcards
What is PID?
A term used to describe infection and inflammation of the female pelvic organs including the uterus, Fallopian tubes, ovaries and surrounding peritoneum.
What causes PID?
Ascending infection from the endocervix causing: Endometritis Salpingitis Parametritis Oophoritis Tubo-ovarian abscess And/ or peritonitis
The ascending infection causes…
Inflammation, which causes damage
Adhesions form
Damage to tubal epithelium
What is salpingitis?
Inflammation of Fallopian tubes
What are the causative organisms?
Sexually transmitted:
Chlamydia trachomatis
Neisseria gonorrhoeae
Enterobacteriaceae:
E. Coli
Anaerobes:
Bacteroides
Peptostreptoccocus
Peptococcus
Usually associated with intrauterine device:
Actinomyces
Gardnerella vaginalis Streptococcus agalactiae Mycoplasma genitalium Mycoplasma hominis Haemophilius influenzae Streptococcus pyogenes
Rare: pelvic tuberculosis
What risk factors are there?
Young age (<25) New sexual partner Multiple sexual partners Early age of first sexual intercourse Non use of barrier contraception Previous PID, chlamydia or gonorrhoea infection Immunocompromised Co existing endometriosis IUD/ coil insertion Termination of pregnancy/miscarriage Instrumentation of uterus Appendicitis
Has it been reported in non sexually active women?
Yes
Is PID often polymicrobial?
Yes in 30-40%
Is it common in the UK and amongst what age group?
Yes - underestimated
Sexually active women: peak 20-30 years
How does it present?
Pain - lower abdominal, deep dyspareunia Pyrexia Discharge abnormal IMB and PCB Dysuria Can be asymptomatic
What examination findings are often seen?
Fever
Lower abdominal tenderness - usually bilateral
Bimanual examination - adnexal tenderness +/-mass , cervical motion tenderness
Speculum examination - lower genital tract infection, purulent cervical discharge, cervicitis
What investigations should be done?
Pregnancy test (urinary+/or serum) - exclude ectopic
FBC, CRP, U and E
Urinalysis - exclude concomitant UTI
Triple swabs - high vaginal and endocervical sent for culture and microscopy
Screening for other STIs including HIV
USS pelvis/abdo - hydrosalpinx, tubo-ovarian abscess
X ray if questing if bowel involvement
Diagnostic = laparoscopy - can also treat at same time e.g adhesiolysis and drain abscess
What does a high vaginal swab test for?
Posterior fornix for: TV BV Candida GBS
What gynaecological differentials are there?
Ectopic pregnancy
Endometriosis
Ovarian cyst complications
What GI differentials are there?
Appendicitis
IBS
What urinary differentials are there?
UTI
If the triple swab is negative, does this exclude PID?
No - there are other causative organisms
Why should there be a low threshold for treatment?
Delay in treatment increases long term sequelae
What is the outpatient treatment?
IM ceftriaxone 500mg single dose Plus PO doxycycline 100mg BD Plus PO metronidazole 400mg BD For 14 days Also give pain relief and antiemetics
In severe disease there is a risk of…
Sepsis
Severe disease requires..
IV antibiotics and admission for observations and possible surgical intervention - laparoscopy/ laparotomy for drainage
What antibiotic inpatient treatment is required?
IV ceftriaxone 2g daily
PLUS IV doxycycline 100mb BD (oral if tolerated)
Followed by oral doxycycline 100mg BD plus oral metronidazole 400mg BD for 14 days
What counselling is required?
Future ectopic risk
Subfertility
Should partners be notified and treated if necessary?
Yes
