PID Flashcards
What is PID?
Pelvic inflammatory disease- acute and subclinical infection of the upper genital tract in women. It comprises a spectrum of inflammatory diseases involving any combo of the uterus, fallopian tubes, ovaries. Often accompanied by involvement of neighboring pelvic organs
what does PID result in?
Results in endometritis, salpingitis, oophoritis, pelvic peritonitis, perihepatitis, and/or tubo- ovarian abcess (TOA)
Acute PID hard to diagnose because of the wide variation in s/s, which are?
unilateral or bilateral lower abdominal or pelvic pain fever vomiting abnormal vaginal discharge irregular vaginal bleeding pain with intercourse
*many episodes of PID go undiagnosed and untreated because ??
the patient and/or practitioner fails to recognize the implications of mild or nonspecific signs and symptoms
Silent PID
term that can be applied to women with very minimal or no symptoms, represents a large portion of all PID cases
what is happening in subclinical PID
mild inflammation is occurring within the reproductive tract at a very low level, yet damage to the fallopian tubes or surrounding structures is occurring
important for clinicians to recognize the implication of mild/ non specific findings, especially
in young female patients who might give an incomplete or inaccurate sexual history
how can PID occur (less likely)
can be blood- borne, ie. TB or result from an intra- abdominal process or gyn procedures that disrupt the protective cervical barrier
how does PID usually occur
most often develops when bacteria ascend from the vagina or cervix into the endometrium, fallopian tubes, and pelvic peritoneum. majority (85%) of cases caused by sexually transmitted pathogen or bacterial vaginosis- associated pathogens
risk factors for PID
a previous h/o of PID higher numbers of lifetime sex partners douching h/o bacterial STD age younger than 25 having a partner with an STI
gyn procedures that disrupt the protective cervical barrier
pregnancy termination IUD insertion dilation and curettage hysterosalpingography - all elevate the risk of PID and may lead to PID in the absence of the classic sexually transmitted pathogen
time course of presentation of PID
typically acute over several days but can be weeks to months
clinical diagnosis remains..
the most important practical approach
15% of cases of PID are NOT sexually transmitted and instead are associated with..
enteric pathogens (E.coli, bacteroides fragilis, group B strep, and campylobacter spp) or respiratory pathogens (h. influenzae, strep pneumoniae, group A strep, and staph aureus) that have colonized in the lower GI tract
what other things can produce a similar clinical picture
post- op pelvic cellulitis and abscess, pregnancy- related pelvic infection, injury or trauma- related pelvic infection, and pelvic infection secondary to spread of another infection
who is at risk?
any sexually active female is at risk for STI associated PID
-those w/ multiple partners at higher risk
PID during pregnancy rare because
the mucus plug and decidua seal off the uterus from ascending bacteria.
PID rare during pregnancy but possible
- can occur within first 12 weeks of gestation before the mucus plug seals off the uterus
our level of suspicion should always be high, especially
in adolescents
what is the goal of the initial evaluation of women with suspected PID?
to establish a presumptive diagnosis of PID
- assess for additional findings that increase the liklihood of that diagnosis
- evaluate for other potential causes of pelvic pain
issues pertaining to high- risk sexual behavior and acquisition of STI are common to both adolescents and adults but
are intensified among adolescents because of both behavioral and biological predispositions
behavioral factors that put adolescents and young women at high risk for STI’s and PID are
inconsistent use of barrier protection
douching
greater number of current/ lifetime sexual partners
use of ETOH and other substances that may impair judgement while engaging in sexual activity
what to use to reduce risk of PID
latex condoms
use of oral contraceptives
may also reduce risk of PID (associated with a decrease in the severity of inflammation)
