Pelvic Inflammatory Disease (PID)

Question 1

pelvic inflammatory disease (PID) - overview

Answer 1

*a polymicrobial infxn of the upper genital tract associated with N gonorrhoeae, Chlamydia trachomatis, and endogenous aerobes/anaerobes
*infection ascends from an anatomically lower region & involves any/all of the uterus or ovaries
*risk factors: multiple sexual partners, uterine instrumentation or procedure, douching, smoking, prior STIs and/or PID

Question 2

pelvic inflammatory disease (PID) - clinical presentation

Answer 2

*sx often develop acutely over a few days
*history: lower abd pain, fever, chills, menstrual disturbances, purulent cervical discharge
*PE: cervical motion, uterine, and/or adnexal tenderness
*orogenital contact that can cause gonococcal pharyngitis along with PID

Question 3

pelvic inflammatory disease (PID) - diagnosis

Answer 3

*presence of acute lower abdominal or pelvic pain, PLUS one of:
-uterine tenderness
-adnexal tenderness
-cervical motion tenderness
*perform hCG test to rule out pregnancy
*best test: NAAT for N gonorrhoeae and C trachomatis
*elevated WBC count
*ultrasound

Question 4

pelvic inflammatory disease (PID) - treatment principles

Answer 4

*antibiotic treatment should NOT be delayed while awaiting culture results; all sexual partners should be examined & treated appropriately

Question 5

pelvic inflammatory disease (PID) - OUTPATIENT treatment regimens

Answer 5

1. ceftriaxone IM (one dose) + doxycycline PO (14 days) +/- metronidazole PO (14 days - covers anaerobic infxns)
   OR
2. ofloxacin/levofloxacin (14 days) +/- metronidazole (14 days): only in special cases

Question 6

pelvic inflammatory disease (PID) - INPATIENT treatment regimens

Answer 6

1. cefoxitin or cefotetan (cephalosporin) + doxycycline for 14 days
   OR
2. clindamycin + gentamicin for 14 days

Question 7

Fitz-Hugh Curtis syndrome

Answer 7

*perihepatitis caused by PID
*presents with PID sx (lower abd/pelvic pain, fever, etc) and concurrent RUQ tenderness to palpation
*happens where the liver capsule becomes inflamed without stromal involvement (ALT and AST are normal or minimally elevated)
*pain in classically pleuritic, radiating to the shoulder

Question 8

pelvic inflammatory disease (PID) - disposition

Answer 8

*when to admit: any pt with vital sign abnormalities (high fever, tachycardia, looks unwell) and/or cannot tolerate PO