PID Flashcards
list the causes of PID
STI- chlamydia, gonorrhoea, Mgen
BV organsims - anaerobic bacili, anaerobic cocci
anaerobes and organisms that make up the vaginal flora - gardnerella,
what are the symptoms associated with pid/
lower pelvic pain, recent onset and often bilateral change to vaginal discharge fever abnormal bleeding - IMB/PCB, deep dyspareunia
What are the signs of PID on clinical examination
lower pelvic tenderness - usually bilaterally adnexal tenderness CME fever purulent discharge
IUD insertion can cause PID?
true or false
False - IUD/IUS insertion increases the risk of developing PID in the next 4-6 weeks (risk is highest in women with pre-existing CT/GC/Mgen at the time of insertion)
Lydia presents to your GUM clinic with acute onset bilateral lower abdominal pain associated with a change in her vaginal discharge. You suspect PID. What investigations would you carry out assuming you are working in a level 3 GUM service?
- observations - check HR and temp especially
- STI screen - HIV and STS bloods + CT/GC vaginal swab
- examination - palpate abdomen, bimanual examination to elicit any adnexal tenderness or CME,
- microscopy : wet and dry microscopy and cervical microscopy + GC culture plate
+/- Mgen if evidence of PID on examination - UPT
Lydia has >20 WBC on cervical and vaginal microscopy, no evidence of GC, UPT negative,
she had bilateral lower abdominal tenderness with CME. Observations were stable.
She is not allergic to anything and has the implant in situ.
How would you treat her?
Rx for PID
stat dose IM 1gram ceftriaxone, 100mg BD doxycycline and 400mg BD metronidazole for 14 days
no sex until her and partner completed RX and symptoms are better
Lydia was treated for PID and her STI screen including Mgen has come back negative. What is the empirical Rx that her partner should be offered?
doxycycline 100mg BD for 7 days
What is the PPV of cervical microscopy demonstrating raised WBC in the diagnosis of PID?
PPV of 17% (i.e. if WBC are present this does not mean it is it PID, lots of other reasons why women may have WBC on cervical microscopy- lacks specificity )
what is the NPV of determining PID in a patient with no WBC on cervical microscopy
95% NPC - high sensitivity for ruling PID out if no WBC on microscopy
A GP rings to ask your advice. She has diagnosed PID in a 23 year old female who is known to have chlamydia. She is worried as the patient has a mirena coil in situ. She is unsure as to whether or not to remove it. Her observations are stable. The last UPSI was 2 days ago.
What would your advice be?
a) remove ASAP
b) watch and wait, review in 72 hours if symptoms improving then remove
c) watch and wait, review in 72 hours if symptoms not improving then remove.
d) watch and wait, review in 72 hours, if symptoms not improving then remove, and consider the need for EC
d - watch and wait, review in 72 hours, if symptoms not improving consider remove but this needs to be balanced against the risk of patient needing emergency contraception.
in a patient whom you suspect PID what would other differential diagnoses that you need to consider be?
ectopic pregnancy appendicitis IBS endometriosis ovarian accident/cyst functional pain
when should you consider admission for IV treatment of PID
Pregnancy
signs of sepsis - pyrexial, tachycardia +/- hypotensive
severe symptoms not improving with oral treatment
surgical cause needs exclusion
Emily has signs and symptoms of PID., You feel she can tolerate outpatient oral treatment but last time she took doxycycline for chlamydia it made her feel very nauseous and she was unable to complete the course.
what is the second line management option?
- ofloxacin 400mg BD + metronidazole 400mg BD for 14 days
You treated Emily for PID with ofloxacin 400mg BD and metronidazole 400mg BD, when you review her symptoms 5 days later they are no better or worse. On reviewing her results you notice her mycoplasma genitalium result has subsequently come back positive.
How would you treat her and what advice should be given for PN?
stop current antibiotic regime, switch to moxifloxacin 400mg OD for 14 days.
No sex until her and partner have been treated and symptoms improved.
advise current RMP to have testing for MGen and only if positive does he require treatment.
TOC for Mgen at 5 weeks (no sooner than 3 weeks)
Emily was treated for Mgen PID. She is worried about future complications especially the risk of infertility. This is the first time she has ever had an STI or been treated for PID.
What are the future complications and what is the risk of infertility?
reassure that the risk of complications usually result from undiagnosed and untreated cases of PID. with prompt treatment the risk of complications can be reduced
risk of infertility is 8% (with 1 epsiode of PID), 20% with 2 episodes and 40% with 3 episodes.
increased risks of ectopic pregnancy in the future and chronic pelvic pain.
