PID

Question 1

What is PID?

Answer 1

Infection of upper genital tract

Question 2

How prevalent is PID?

Answer 2

Often asymptomatic so many cases undetected; prevalence difficult to ascertain

Question 3

What are the causes of PID?

Answer 3

Normally ascending infection from endocervix (typically mixed infection)
-STIs
-Uterine instrument e.g. hysteroscopy, insertion IUCD, TOP
-Post partum
-Miscarriage
Descending infection from other organs e.g. appendicitis
Chlamydia and Gonorrhoea (25%)
Remainder from anaerobes and endogenous bacteria

Question 4

What factors in a history increase the risk of PID?

Answer 4

<25y
Previous STIs
New/multiple sexual partners

Question 5

What is protective against PID?

Answer 5

Barrier protection
Mirena coil IUCD
COCP

Question 6

What would be found in a typical PID Hx?

Answer 6

Lower abdo pain (uni/bilateral), constant or intermittent
Deep dyspareunia
Discharge
IMB/PCB
Dysmenorrhoea 
(fever)

Question 7

What would be seen in PID on examination?

Answer 7

Vaginal discharge
Cervical motion tenderness (cervical excitation) +/- adnexal tenderness
May be afebrile in mild/moderate PID

Question 8

What Ix would be done for PID?

Answer 8

Vulvovaginal/endocervical swabs for C and G (and MC&S urine)
If acutely unwell - FBC (inc WCC), CRP, blood cultures if ?sepsis
Arrange TVS if tubo-ovarian abscess suspected
Laparoscopy not indicated unless diagnosis is uncertain (e.g. RIF pain and possible appendicitis) or for drainage of cyst

Question 9

What complications are associated with untreated PID?

Answer 9

Tubo-ovarian abscess
Fitz-Hugh-Curtis syndrome (inflam of liver capsule with peripheral adhesions)
Recurrent PID
Ectopic pregnancy
Subfertility from blocked tube (8% after one episode; 40% after 3 episodes)

Question 10

What is the general management process for PID?

Answer 10

Prompt, contact tracing minimises complications
Abx before culture
Outpatient vs inpatient management if necessary

Question 11

What is the outpatient management of PID?

Answer 11

Ceftriaxone 500mg IM stat or
Azithromycin 1g+ doxycycline 100mg PO BD 14d and metronidazole 400mg PO BD 14d
If gonorrhoea suspected - consult micro

Question 12

What is the inpatient management of PID?

Answer 12

Ceftriaxone 2g IV OD + doxycycline 100mg IV BD, followed by oral doxycycline 100mg PO BD for 14d + metronidazole 400mg PO BD for 14d

Question 13

What is chronic PID?

Answer 13

Unresolved, unrecognised or inadequately treated infection.
Inflammation leads to fibrosis, so adhesions develop between pelvic organs; tubes may be distended with pus (pyosalpinx) or fluid (hydrosalpinx)
Difficult to manage, abx generally not helpful

Question 14

What are the symptoms of chronic PID?

Answer 14

Pelvic pain
Menorrhagia
Secondary dysmenorrhoea
Discharge
Deep dyspareunia

Question 15

What could be seen on examination?

Answer 15

Tubal masses
Tenderness
Fixed retroverted uterus

Question 16

What may coexist with PID?

Answer 16

Endometritis