Pelvic inflammatory disease (PID)

Question 1

Background

Answer 1

PID = General term for infection of the upper genital tract.
Affects sexually active young women
Infection can spread upwards, causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess, and/or pelvic peritonitis in severe cases.

Causes of PID: STIs (chlamydia, gonorrhoeae, genitalium)

Risk factors:
- Poor sexual health
- previous PID
- Multiple partners

Complications:
The risk of complications increased with severe/repeated infections. Non infection complications are ectopic pregnancy, tubal factor infertility, and chronic pelvic pain.

Question 2

Signs and symptoms

Answer 2

• Pelvic or lower abdominal pain (usually bilateral but can be unilateral).
• Deep painful sex, esp recent onset.
• Secondary dysmenorrhoea.
• Abnormal vaginal bleeding (intermenstrual, postcoital, or heavy menstrual bleeding)
• Abnormal vaginal or cervical mucopurulent discharge
• RUQ pain or right shoulder pain.
  Systemic symptoms such as fever (may be absent), N or V (may be present in half) or malaise.
  PID may be asymptomatic in some.

Question 3

Diagnosis

Answer 3

Made based on clinical features.
Do general abdominal, pelvic exam:
- check fever, lower pain, mucuprulent discharge.
Can do investigations:
- STI tests. Swabs to check.
- Blood test (lecucyte, CRP, ESR, check HIV, Syphilis, hepatitis)
IF SUS GIVE EMPERICAL ANTIBIOTICS

Question 4

Treatment

Answer 4

Urgent refer to hospital if pregnant, systemically unwell, symptoms showing complications.
Seek advise if IUD, HIV, complications

NON PHARMACOLOGICAL
- Abstain from sex, Keep in IUD, Advise to attend STI screen and treatment.

PHARMACOLOGICAL:
- OTC paracetomal and/or ibuprofen for pain

RISK OF GONOCOCCAL INFECTION HIGH=
- Ceftriaxone 1g single IM dose, THEN oral doxycycline 100mg BD+oral metronidazole 400mg BD for 14 days.

RISK OF GONOCOCCAL INFECTION LOW=
1ST line - Same as high risk
2ND line - ONE of these regimens:
- Oral ofloxacin 400mg BD + oral metronidazole 400mg BD 14 days, OR
- Oral levofloxacin 500mg OD + oral metronidazole 400mg BD 14 days, OR
- Oral moxifloxacin 400mg OD 14 day

INITIAL TEST RESULT FOR MYCOPLASMA GENITALIUM IS POSITIVE:
- Oral moxifloxacin 400mg OD 14 day

ALL 1ST/2ND LINE NOT TOLERATED:
- Ceftriaxone 1g single IM dose, THEN oral azithromycin 1g/week for 2 weeks.

Question 5

Follow up

Answer 5

Review in 72 hours.
Check anitbiotic sensitivity from swab results.
IF VAGINAL SWABS NEGATIVE CONTINUE treatment.
Can discuss another review in 2-4 weeks after antibiotics course finishes.
Advise on sexual health.
Specialist to do test of cure
Advise them to get in to contact with sexual paretner in past 6 months to go to a STI screen