Pelvic Inflammatory Disease

Question 1

Pelvic Inflammatory Disease Definition

Answer 1

General term for infection of the upper female genital tract including uterus, Fallopian tubes, ovaries
-Usually ascending infection from the cervix, common and serious complication of STIs

Question 2

Pelvic Inflammatory Disease Epidemiology

Answer 2

• Underdiagnosed and often asymptomatic

- Most common in 20-29 year olds

Question 3

Pelvic Inflammatory Disease Aetiology

Answer 3

• Often polymicrobial

- Endogenous flora, genital mycoplasms, bacterial vaginosis bacteria, STIs

Question 4

Pelvic Inflammatory Disease Presentation

Answer 4

• No combination of symptoms make a diagnosis, must have a high index of clinical suspicion
• Bilateral lower abdominal pain
• Deep dyspareunia
• Abnormal vaginal bleeding
• Purulent discharge

Question 5

Pelvic Inflammatory Disease Differentials

Answer 5

• Apendicitis, ectopic
• Other causes of abnormal bleeding
• Other causes of discharge
• Other causes of dyspareunia e.g. endometriosis

Question 6

Pelvic Inflammatory Disease Ix

Answer 6

• Pregnancy test (ectopic)
• Cervical swabs for chlamydia and gonorrhoea, negative result does not exclude
• Swabs for C. trachomatis, N. gonorrhoeae using nucleic acid amplification tests
• Test for mycoplasma genitalium
• Laparoscopy is best test but not always appropriate
• Urinalysis and culture (exclude UTI)

Question 7

Pelvic Inflammatory Disease Management

Answer 7

• IM ceftriaxione, metronidazole, doxycycline
• Do not delay treatment while awaiting test results (increases risk of complications)
• Avoid intercourse until treated, treat partner
• If severely ill IV ceftriaxone and metronidazole, then 14 day course of doxycycline and metronidazole

Question 8

Pelvic Inflammatory Disease Management of Sexual Partners

Answer 8

• Avoid intercourse until they and their partner have completed treatment
• Screen for other STIs

Question 9

Pelvic Inflammatory Disease Admission Criteria

Answer 9

• Diagnostic uncertainty (e.g. ectopic, appendicitis)
• Severe symptoms or signs
• Deteriorating
• Clinical failure with oral treatment
• Abscess
• Pregnancy

Question 10

Pelvic Inflammatory Disease Complications

Answer 10

-Infertility, ectopic, chronic pain, Fitz-Hugh-Curtis syndrome (RUQ pain), abscesses, reiters