PID

Question 1

_____ is a clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.

Answer 1

Pelvic Inflammatory dz

Question 2

Pelvic Inflammatory dz Comprises a spectrum of inflammatory disorders including any combination of ___, ____, ____, and _____.

Answer 2

endometritis
salpingitis
tubo-ovarian abscess
pelvic peritonitis

Question 3

what are RF for PID? (there’s a lot.. 9 to be exact)

Answer 3

Adolescence
Hix of PID
Gonorrhea or chlamydia
Multiple partners
Current douching
Insertion of IUD
BV
Demographics (socioeconomic status)
Oral contraceptive use (in some cases)

Question 4

Most cases of PID are _____ (i have no good hints for this)

Answer 4

polymicrobial

Question 5

What are common pathogens involved in PID?

Answer 5

N. gonorrhoeae
- cervix in 30%-80% of women with PID

C. trachomatis
- cervix in 20%-40% of women with PID

N. gonorrhoeae and C. trachomatis are present in combination in approximately 25%-75% of patients

Question 6

what are less common pathogens involved in PID?

Answer 6

E.coli (aerobic gram (-) rod)

Bacteroides spp., Prevotella spp., Peptostreptococcus spp. (anareobes, especially associated with BV)

Streptococcus spp (Gram-positive organisms)

Mycoplasma genitalium and Ureaplasma urealyticum

Question 7

what is the pathway of ascendant infection for PID?

Answer 7

Cervicitis–> endometritis –> Salpingitis/oophoritis/tuboovarian abscess –> peritonitis

Question 8

when there is infection (PID) there is a destruction of ___ (structure) histologiclaly

Answer 8

cilia

Question 9

___ is thought to be present 60% of the time, notable because it lacks symptoms. women usually complain of dyspareunia, dysuria, irregular bleeding, GI sxs

Answer 9

Subclinical disease (PID)

Question 10

___ is overt mild to moderate PID, women may complain of lower abdominal pain or pelvic pain, cramping, or dysuria. They may also exhibit signs such as intermittent or post-coital bleeding, vaginal discharge, or fever.

Answer 10

symptomatic (PID)

Question 11

what PE signs may be present in symptomatic PID

Answer 11

Uterine tenderness
cervical motion pain
adnexal tenderness (may be most sensitive sign)

Question 12

___ occurs when women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC). Other laboratory indicators, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may also be elevated.

Answer 12

Severe PID

Question 13

subclinical PID occurs ___% of the time
mild-moderate sx ___%
Severe sxs ___%

Answer 13

60%
36%
4%

Question 14

Approximately ___% of women with a single episode of PID will experience sequelae, such as ___, ____, ____, or ____

Answer 14

25

ectopic pregnancy, infertility, or chronic pelvic pain

Question 15

Ectopic pregnancy is increased __-___x after PID

Answer 15

6-10x

Question 16

Tubal infertility occurs in…
___% of women after one episode of PID
___% of women after two episodes
___% of women after three episodes

Answer 16

8%
20%
50%`

Question 17

what other (obscure) clues may suggest a pt has PID?
Temperature >\_\_\_\_
Abnormal cervical or vaginal \_\_\_\_\_
Presence of \_\_\_\_ on saline wet prep 
Elevated \_\_\_\_\_ and \_\_\_\_\_\_
\_\_\_ or \_\_\_ test positive

Answer 17

Temperature >38.3°C (101°F)
Abnormal cervical or vaginal mucopurulent discharge
Presence of WBCs on saline wet prep
Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Gonorrhea or chlamydia test positive

Question 18

what can you ude to dx PID?

Answer 18

Endometrial biopsy
Transvaginal sonography or MRI
Laparoscopy

Question 19

What is a sign you may see on U/S that suggests the pt has PID?

Answer 19

TOA (tubal ovarian abscess)

Question 20

____ is a complication of gonococcal or chlamydial salpingitis.

Answer 20

Fitz-Hugh-Curtis Syndrome

Question 21

Fitz-Hugh-Curtis Syndrome is characterized by ____ pain in association with acute salpingitis, indicating ___.

Answer 21

right upper quadrant pain

perihepatitis

Question 22

what can Fitz-Hugh-Curtis Syndrome be mistaken for?

Answer 22

Acute cholecystitis

Question 23

what is the criteria for hospitalization for PID?

Answer 23

pregnancy
non-response to oral therapy
severe illness, N/V, hihg fever, TOA
HIV with low CD4 count

Question 24

What is the tx for PID?

Answer 24

Ceftriaxone + Doxy/metronidazole

Cefoxitin +Doxy/metronidazole

(IV: Cefotetan + Doxy or Cefoxitin + doxy, Clindamicin + gentamicin)

Question 25

how long should a pt be on the tc regimen for PID?

Answer 25

least 24 hours after substantial clinical improvement

then
Complete a total of 14 days therapy with
one of the regimens mentioned in earlier cards (see study guide)

Question 26

what pt education is important when treating a woman for PID?

Answer 26

NO sex, sorry ……

until therapy is completed, symptoms have resolved, and sex partners have been adequately treated

Question 27

All women who received a diagnosis of acute PID should be tested for ___, as well as ____ and ____, using NAAT.

Answer 27

HIV

GC and chlamydia

Question 28

Patients being treated for PID should demonstrate substantial improvement within ___ hours.

Answer 28

72 hrs

Question 29

All women diagnosed with gonorrhea or chlamydia should be retested ____ after treatment regardless of whether their partner has been treated.

Answer 29

3 months

Question 30

who is screening for chlamydia recommended for?

Answer 30

Annual chlamydia screening is recommended for:
Sexually active women 25 and under
Sexually active women >25 at high risk

Screen pregnant women in the 1st trimester.