PID

Question 1

List the microbes commonly implicated in PID

Answer 1

• Neisseria gonorrhoeae
• Chlamydia trichomatis
• Gardnerella vaginalis
• Anaerobes: Prevotella, Atopobium, Leptotrichia
• Mycoplasma genitalium
• E coli
• Aerobic streptococci
• Bacteroides fragilis
• Peptostreptococcus

Question 2

What are the risk factors for PID?

Answer 2

Age <30 years
Multiple sexual partners.
New sexual partner.
Non-condom use.
Sex worker.
Recent IUD insertion.
Recent TOP.
Postpartum.
Upper genital tract instrumentation.

Question 3

What investigation result has good negative predictive value for PID?

Answer 3

Absence of white cells on genital swab Gram-staining.
NPV 95%.
Presence of white cells however is non-specific PPV 17%.

Question 4

First-line outpatient antibiotic regimen for PID treament

Answer 4

IM ceftriaxone 1g or IV cefoxitin 1g stat followed by 2 weeks of oral doxycycline 100 mg BD and metronidazole 400 mg BD.

Question 5

First-line INpatient antibiotic regiment for PID treatment

Answer 5

Ceftriaxone 2g IV daily plus doxycycline 100 mg BD.

At discharge:
Doxycycline 100 mg po BD plus metronidazole 400 mg po BD for 2 weeks

Question 6

INpatient antibiotic regiment for PID treatment if patient has cephalosporin anaphylaxis

Answer 6

Clindamycin 900mg IV TDS plus gentamicin IV once daily

At discharge:
Doxycycline 100 mg po BD plus metronidazole 400 mg po BD for 2 weeks

Question 7

What follow-up should you organise for a patient with PID?

Answer 7

Review 2-4 weeks after antibiotics completed.
Check adequate clinical response.
Check compliance.
Check contact tracing.
Discuss significance of PID and long term sequelae.
Repeat pregnancy test if required.

Question 8

When is a test of cure indicated following PID?

How soon can test of cures be performed?

Answer 8

Indications:

• Persisting symptoms
• Not compliant with antibiotics
• Reinfection concerns

Gonorrhoea: 2-4 weeks after treatment
Chlamydia: 5 weeks after treatment

Question 9

What are the short and long term complications of PID?

Answer 9

Fitz-Hugh-Curtis syndrome.
Ectopic pregnancy.
Infertility.
Chronic pelvic pain.
Pregnancy: maternal and fetal morbidity.

Question 10

When to consider laparoscopy for a TOA?

Answer 10

> 8cm
No improvement after 72 hours
Sepsis
Ruptured TOA

Question 11

USS features of a TOA?

Answer 11

Incomplete septae within the tubes is a sensitive sign of tubal inflammation

Cogwheel sign- thickened endosalpingeal folds

Question 12

Risks of laparoscopy for TOA

Answer 12

surrounding organs can be pulled in to TOA e.g. ureter, bowel and there’s an increased risk of organ injury

Question 13

Poor prognostic features for TOA

Answer 13

larger than 5 cm,
age (older women above the age of 40 years)
higher initial white cell count
smoking

Question 14

US/CT guided drainage of TOA

Answer 14

Benefits: likely to be rapid symptom improvement, resolution of pyrexia
a decreased length of hospital stay
Minimally invasive with less surgical risk

Can be performed via the transabdominal, transvaginal, transrectal or transgluteal route.

The success rate is reported between 83% and 100%.38