PID Flashcards
How long does IUD increase risk of PID for?
First 4-6 weeks post fit
Sx of PID
Bilat lower abdomen pain Abnormal d/c Deep dyspareunia Abnormal vaginal bleeding Secondary dysmenorrhea
Signs of PID
Bilat lower abdo tender
Adnexal tenderness
Cme
Fever >38 in mod to severe
PID complications acute
- Fitz- Hugh Curtis syndrome - RUQ pain with peri hepatitis. Particularly with CT. usual RX
- tubo-ovarian abscess - uss/ admit
- m
When to remove IUD if Rx for PID not improving
48-72 hours
Consider PT risk and need for EC
Long term complications of PID
Increase risk ectopic
Infertility
Chronic pelvic pain
What to tell patient when diagnose with PID?
- Rx and side effects
- Following Rx fertility usually maintained but remains risk of future infertility, ectopic, chronic pelvic pain
- Repeat episodes increase risks of fertility
- earlier Rx better
- condoms reduce risk
- screen contacts
1st line abx regime for PID
Cef 1g IM +
Doxycycline 100mg BD 14/7 +
Metronidazole 400mg BD for 14/7
2nd line RX for PID
2 options
Ofloxacin 400mg BD +
Metronidazole 400mg BD for 14/7
Or
Moxifloxacin 400mg OD for 14/7
If suspect GC PID, which abx to avoid?
Ofloxacin and moxifloxacin as quinolone GC resistance high
Alternative to ofloxacin in Rx of PID due to daily dosing?
Levofloxacin
500mg OD for 14/7
Main side effect of moxifloxacin
Serious liver reactions but these are rare
Tendon, muscle joint problems
Risk of quinolones
- Moxi, ofloxacin, levofloxacin
- Can give permenant disabling side effects involving tendons, muscles, joints and the nervous system
- Only use second line except in M Gen
- Not licensed for under 18s
3rd line alternative PID regime
Cef IM plus azithromycin 1g/week for 2 weeks
Ideally if M GEn neg as can cause resistance to MGen
Inpatient PID 1st line
Cef 2g daily IV plus iv doxy 100mg BD + metronidazole 400mg BD oral for total 14/7
Inpatient PID 2nd line
Iv clindamycin 900mg tds plus Iv gent (2mg/kg loading) then 1.5mg/kg tds (can give OD 7mg/kg if prefer)
Followed by
Oral clindamycin 450mg qds or oral doxy 100mg bd plus
Oral metronidazole 400mg bd to complete 14/7
Alternative IP PID regimes
Iv ofloxacin BD plus IV met 500mg tds for 14/7
Or
Iv ciprofloxacin 200mg BD plus
IV or oral doxy 100mg bd plus
Iv metronidazole 500mg TDS for 14/7
Follow up schedule for PID
72 hour review
Further review 2-4 weeks post
If CT positive when to do TOC?
3-5 weeks post if ongoing PID Sx
If GC pos when to repeat TOC?
2-4 weeks post
If M gen positive PID when repeat testing
Give moxi
Retest 4/52 post starting RX
PN from PID
NAAT for all partners in past 6/12
If M gen test partner
Offer all doxy 100mg bd for 7/7 and no sex
