PID

Question 1

Acute PID aetiology, protective and risk factors

Answer 1

Sexual factors 80%
Protective: Barrier contraception, also slightly COC and Mirena
Risk factors: Uterine instrumentation (TOP, ERPC, laparoscopy, IUCD insertion); Complications of childbirth and miscarriage (more often non-sexually transmitted bacteria)

Question 2

Acute PID Clinical features

Answer 2

Asymptomatic - present later with subfertility or menstrual problems
Bilateral lower abdominal pain with deep dyspareunia
Severe cases: tachycardia, high fever, lower abdominal peritonism, cervical excitation
Mass (pelvic abscess) palpable vaginally

Question 3

Acute PID Treatment

Answer 3

Analgesia
Antibiotics (ceftriaxone followed by doxycycline plus metronidazole or ofloxacin with metronidazole)
Febrile patients admitted for IV drugs
Diagnosis reviewed after 24 hours if no significant improvement

Question 4

Chronic PID - what?

Answer 4

Persisting infection, result of non or inadequate treatment of acute PID
Dense pelvic adhesions and obstructed and dilated fallopian tubes

Question 5

Chronic PID clinical features

Answer 5

Chronic pelvic pain
Dysmenorrhoea
Deep dyspareunia
Heavy, irregular menstruation
Chronic vaginal discharge
Subfertility
Abdominall and adnexal tenderness
Fixed retroverted uterus

Question 6

Chronic PID diagnosis

Answer 6

Laparoscopy

Question 7

Chronic PID treatment

Answer 7

Analgesia
Antibiotics if evidence of active infection
Cutting off adhesions, sometimes salpingectomy required