Pelvic Inflammatory Disease (PID) Flashcards
List the three major consequences of PID
- Infertility
- Ectopic Pregnancy
- Chronic Pelvic Pain
What is PID?
Pelvic Inflammatory Disease refers to infection in the upper female reproductive tract (Uterus, fallopian tubes(salpinges), ovaries, or surrounding tissues
What are most cases of PID caused by?
Sexually Transmitted Diseases
Describe how PID is diagnosed
- Pelvic Exam
- Imaging
- Surgical Techniques
Clinicians tend to “over diagnose” PID rather than “underdiagnose” it
Explain the relationship between douching and PID
Can possibly force bacteria into the Endometrium
Describe the characteristics of women most at risk for PID
Sexually active younger women with unsafe sex practices (more likely to get N. Gonorrhoeae and C. Trachomatis)
Describe case management of women with PID
Partner Referrals
- Refer sex partners for examination and treatment if they have had sexual contact during the 60 days prior to symptom onset
- Sex partners should be treated for both N. Gonorrheae and C. Trachomatis regardless of which pathogen is isolated from the woman.
Information for patients
- How to take prescribed medication and return for follow-up visits
- Refrain from sex until medication is completed for you and partners
- Return if symptoms persist or recur
- Refer sex partners for examination and / or treatment
- Adopt a realistic risk-reduction plan
Symptoms of Subacute PID are:
- Heaviness or dull aching of lower abdomen
- Fever of 99 - 100
- Dyspareunia (Pain during or after sexual intercourse
- Backache
- Malaise
Only about 20% of patients will have all these symptoms
Can resemble normal menstrual discomfort
What is Silent PID
A term applied to women with minimal or no symptoms
- Inflammation occurs within the reproductive tract at a very low level, yet damage to the fallopian tubes or surrounding structures is still occuring.
What is Gonoccal PID
The most common cause of acute PID
- Lower abdominal pain and tenderness
- Fevers
- Onset of symptoms after menstruation
- Cervical motion tenderness on physical exam
- Purulent discharge (pus) is more commonly seen in the upper reproductive tract (Endometrium, fallopian tubes, and surrounding tissues) in Gonococcal PID compared to PID caused by other organisms
PID caused by other organisms
PID caused by organisms other than N. Gonorrhoeae characteristically has a more subtle presentation
Women have a low fever or none at all, mild abdominal pain, minimal cervical motion tenderness.
Can be more dangerous because symptoms are mild enough that patient may not feel sick enough to see a doctor
Development of PID:
Infection of the Endometrium
Under normal conditions, the cervix has a thick plug of mucus that helps to prevent the passage of organisms through the cervix into the endometrium.
During menstruation, this plug is discharged, which is thought to allow organisms access to the endometrium. PID from Gonorroheae commonly occurs during menses.
Development of PID:
Infection of the Endometrium
Under normal conditions, the cervix has a thick plug of mucus that helps to prevent the passage of organisms through the cervix into the endometrium.
During menstruation, this plug is discharged, which is thought to allow organisms access to the endometrium. PID from Gonorroheae commonly occurs during menses.
Development of PID:
Spread of infection
Once in the endometrium, the organisms can spread to the fallopian tubes and to the surrounding structures (such as ovaries and supporting ligaments of the uterus). This spread, and the resulting inflammation, results in the symptoms of PID
- Can occasionally extend up to the liver
- The endometrium is involved in all cases of PID, and the fallopian tubes are involved in the large majority of cases.
Development of PID:
Abscess
If inflammation is severe, an abscess can develop. When occurring in the fallopian tube they are called “tubo-ovarian abscesses” - a collection of pus, with surrounding tissue that is very inflamed, tender, and painful.
Abscesses are serious as they may rupture, spilling pus into the peritoneum
Who gets PID?
PID is rare in virgins. Most at risk are sexually active younger women with unsafe sex practices. (More likely to get N. Gonorrhoeae and C. Trachomatis).
Women who have PID caused by other organisms tend to be older, many in their 30s, with safer sex practices. More likely that other organisms causing PID is from an overgrowth of the woman’s endogenous vaginal flora rather than organisms acquired from a new sex partner.
Who gets PID?
PID is rare in virgins. Most at risk are sexually active younger women with unsafe sex practices. (More likely to get N. Gonorrhoeae and C. Trachomatis).
Women who have PID caused by other organisms tend to be older, many in their 30s, with safer sex practices. More likely that other organisms causing PID is from an overgrowth of the woman’s endogenous vaginal flora rather than organisms acquired from a new sex partner.
What are some non-sexual causes of PID?
- Surgery
- Intrauterine Device (very low risk)
- Douching
- Pregnancy-related procedures
What percentage of women meeting the minimum set of criteria actually have PID?
65 %
Other causes of abdominal pain
The two most important causes of lower abdominal pain in women are:
- Ectopic pregnancy
- Appendicitis
Other causes of abdominal pain
The two most important causes of lower abdominal pain in women are:
- Ectopic pregnancy
- Appendicitis
What is the importance of timely diagnosis and treatment of PID
After one episode of acute PID, about 25% of women will suffer one of the 3 major complications. After two episodes, this percentage increases to 40.
Damage can be prevented by prompt therapy
PID Treatment:
Therapy
PID therapy is directed at the organisms that cause PID and, in particular, N. Gonorrhoeae and C. Trachomatis.
Normally treated with a long course (14 days) of antimicrobials. This is necessary because the infection is well established in tissues that antimicrobials may not be able to reach very well.
HIV and PID considerations
HIV may increase the risk for PID.
- Women newly diagnosed with HIV should have a pelvic examination.
HIV + PID = More likely to have tubo-ovarian abscess
- Still responds well to standard antibiotic regimens.
HIV and PID considerations
HIV may increase the risk for PID.
- Women newly diagnosed with HIV should have a pelvic examination.
HIV + PID = More likely to have tubo-ovarian abscess
- Still responds well to standard antibiotic regimens.
Which of the following organisms are not associated with PID?
A. N. Gonorrohoea B. Chlamydia Trachomatis C. Treponema Pallidum D. Mycoplasma Genitalium E. C and D
E
Which of the following organisms are not associated with PID?
A. N. Gonorrohoea B. Chlamydia Trachomatis C. Treponema Pallidum D. Mycoplasma Genitalium E. C and D
C. Treponema Pallidum
Which outcome(s) below may result from PID?
A. Infertility
B. Ectopic Pregnancy
C. Chronic Pain
D. All of the above
E. None of the above
D.
PID is diagnosed by:
A. Laboratory tests
B. A bi-manual exam
C. Clinical signs and symptoms
D. All of the above.
D.
PID is diagnosed by:
A. Laboratory tests
B. A bi-manual exam
C. Clinical signs and symptoms
D. All of the above.
D.
The minimum criteria for diagnosing PID in sexually active young women and women at risk are:
A. A positive laboratory test or vaginal bleeding
B. Presence of adnexal tenderness, cervical motion tenderness or uterine tenderness
C. Visible infection or scarring upon laparoscopic examination
D. Menstrual irregularities or perihepatitis.
B
Which of the following is not known to be a casual factor of PID?
A. Douching
B. Surgery involving the genital tract
C. Spermicide
C.
Which of the following women are at risk for developing PID?
A. Young, sexually active women who do not practice safe sex
B. Women infected with N. Gonorrhoeae
C. All of the above
C.
Which of the following statements regarding PID Case Management is true?
A. Case management is an effective means of primary prevention of PID.
B. PID is a reportable condition in every state.
C. Sex partners of a woman with PID should be treated for both N. Gonorrhoeae and C. Trachomatis regardless of the pathogens isolated from the woman.
D. Sex partners of a woman with PID should be referred for examination and treatment if they had sexual contact with the woman during the 90 days preceding onset of symptoms.
C
