PID

Question 1

2 ways to get it

Answer 1

Sexually: chlamydia

Non-SExually: endogenous
-post surgical

Question 2

Why pelvic ultrasound in PID?

Answer 2

Check for pyosalpinges, oophritis, Cervicitis

Question 3

The most common presentation of chlamydia?

Answer 3

ASYMPTOMATIC

Question 4

How many chlamydia go symptomatic?

Answer 4

10% of symptomatic infections progress to PID

Question 5

Rx for chlamydia?

Answer 5

Azithromycin 1g stat

Resistance is rare

CONTACT TRACING

Question 6

When do you need test of cure?

Answer 6

If not Rx with Azithromycin?
6-12 weeks

Pregnant women

Question 7

If getting PID, what Rx? Mod

Answer 7

Ceftriaxone plus metronidazole plus Azithromycin

Then Azithromycin a week later

Question 8

If Severe PID?

Answer 8

IV antis, admit

Question 9

Mirena too long in, problems?

Answer 9

• Stuck and infected - 10 years

- No longer have contraception

Question 10

Actinomyeses? Ix?

Answer 10

Actinomyosis culture (takes 2 weeks)
No PCR for it.

Question 11

PID in IUD RX?

Answer 11

Remove IUD

Antibiotics

Question 12

If PID with abscess Rx? And she’s unwell.

Answer 12

Drain it. U/S guided
Laparoscopy
Give ABx prior to prevent sepsis

Question 13

If confirmed actinomyces? Rx?

Answer 13

Prolonged Abx

Colonization: check ID

Question 14

PID non sexually acquired risks?

Answer 14

Ascending infection
Post surgical, D&C hysterosalpingogram, IUD inserition
Retained products

Question 15

PID and IUD

Answer 15

Take swabs
Risk of PID doesn’t increase once it’s in.
Mirena may be protective b/c progesterone

Question 16

if have IUD, and has chlamydia?

Answer 16

Treat and take it out. Test to make sure it’s gone before putting it back in.
especially if nulliparous

Question 17

Actinomyces Is?

Answer 17

Gram+ve anaerobic bacillus
Normal flora
LOVES IUD colonization
Can cause tubo ovarian abcess, drain: then IV Abx 1-2 days prior.

Question 18

Cervicitis presentation?

Answer 18

Discharge
Post-coital bleeding
Abnormal Pap smear-inflammatory cells causing abnormal pap

Question 19

What worries about post-coital bleeding?

Answer 19

Cervical cancer

Question 20

Most common cause of post-coital bleeding?

Answer 20

Ectropion

Question 21

If have post-coital bleeding and pap smear is normal, safe?

Answer 21

Nope. Screening test only. Need colposcopy if ongoing symptoms

Question 22

Likely organism for bacterial vaginosis?

Answer 22

Mixed anaerobes - Endogenous imbalance

Question 23

What increase risk of bacterial vaginosis?

Answer 23

Douching,
Increasing pH
Sex worker

Question 24

Vaginosis Rx?

Answer 24

Metronidazole
Metronidazole gel
Clindamycin
Treat only if
Symptomatic, pregnant, before gynaecological
High recurrence

Question 25

Vaginal candidiasis

Answer 25

Albicans

Candida GalbraTa

Question 26

Chronic vaginal thrush?

Answer 26

More than 4 per year

Grows into vulva, swabs are negative, but has it

Question 27

Non-Albicans Candida Rx?

Answer 27

Boric acid pessary, FATAL if oral.

Question 28

Candidiasis prevalence?

Answer 28

More in high oestrogen if state
Rare in post-menopausal
Progesterone OCP may help

Question 29

Trichomonas is presentation?

Answer 29

Yellow green ‘FISHY’ smell

Question 30

Rx of trichomonas is?

Answer 30

Metronidazole