PID

Question 1

What is PID?

Answer 1

an infection of the upper genital tract incl. the womb, fallopian tubes, and ovaries

Question 2

Which group is most likely to develop PID?

Answer 2

sexually active girls ages 15-24

Question 3

What are the most frequent symptoms in PID?

Answer 3

pain around pelvis or lower abdomen
discomfort or pain during sex felt deep inside pelvis
painful urination
bleeding between periods and after sex
heavy periods
painful periods
unusual vaginal discharge

Question 4

What are the more severe symptoms sometimes associated with PID?

Answer 4

fever
severe lower abdo pain
N&V

Question 5

What are the most common causes of PID?

Answer 5

bacterial infection from lower genital tract that has spread up
in may cases it is due to >1 type of bacteria
~1/4 cases it is caused by an STI
Other bacteria that normally live in the vagina can cause infection if previous damage/opening of cervix, or previous PID

Question 6

What things can get infected to cause PID?

Answer 6

endometrium
Fallopian tubes
tissue around the womb
ovaries
peritoneum

Question 7

Which groups of women are most at risk of developing PID?

Answer 7

>1 sexual partner
new sexual partner
history of STIs
had PID in the past
<25
started having sex at a young age

Question 8

How can PID be diagnosed?

Answer 8

history - sexual and medical
pelvic exam - bimanual + abdo palpation
swabs of vagina and cervix
urine or blood tests
pregnancy test
USS - transvaginal
severe cases may need laparoscopic surgery

Question 9

When should someone with PID be admitted to hospital?

Answer 9

PID + pregnancy esp. if risk of ectopic
severe symptoms
signs of pelvic peritonitis
abscess suspected
unable to take oral abx
may need emergency surgery - appendicitis suspected also

Question 10

What is the DDx for PID?

Answer 10

ectopic pregnancy
endometriosis
functional pain
UTI
acute appendicitis
ovarian cyst complications
postnatal endometritis

Question 11

What is the treatment for simple PID?

Answer 11

Ofloaxacin + metronidazole for 2 weeks

Question 12

What is the treatment for PID if at high risk of gonorrhoea?

Answer 12

IM ceftriaxone (single dose), doxycycline + metronidazole

Question 13

If a patient has to be admitted to hospital with PID what is the treatment used?

Answer 13

Iv ceftriaxone + IV metronidazole + PO doxycycline

Oral step-down = doxycycline + metronidazole to complete 14days

Question 14

How is PID treated in hospital if penicillin allergic?

Answer 14

IV Clindamycin + IV Gentamicin

Question 15

How is PID in pregnancy treated?

Answer 15

IV ceftriaxone + IV erythromycin + IV metronidazole

Step down to PO erythromycin and metronidazole

Question 16

Other than antibiotics what other advice is give to patients with regards to the treatment of PID?

Answer 16

rest
analgesia
sexual abstinence until they +partner have completed any needed treatment

Question 17

What is the follow up for someone presenting with PID?

Answer 17

current partner offered sexual health screening and treatment
review outpatients at 72h - if not improving, admission necessary
review after 2-4 weeks to assess response and arrange nay further tests

Question 18

What are the complications of PID?

Answer 18

recurrence
abscess
long-term pelvic pain
ectopic pregnancy
infertility