Pid Flashcards
What is PID
The result of infection ascending from the
endocervix, causing endometritis, salpingitis,
parametritis, oophoritis, tubo-ovarian
abscess and/or pelvic peritonitis”
Describe the pathophysiology of PID
• Ascending infection from the endocervix and
vagina
• Infection causes inflammation
• Inflammation causes damage
– Thus damaged tubal epithelium - desquamation
– Thus adhesions form, scarring, in pelvis
• Some recovery of tubal epithelium does occur
What is endometriosis
Inflammation and infecton of the endometrium - plasma cells on biopsy
What is salpingitis
Inflammation of the Fallopian tube - exudate, swelling, loss of function (carrying egg, sperm), adhesions, distortion
Describe the aetiology of PID
• Sexually transmitted infections – Chlamydia trachomatis D-K – Neiserria gonorrhoea • Others – Gardnerella vaginalis – Mycoplasma hominis – Anaerobes – Actinomycosis • Often polymicrobial
Describe the epidemiology of PID s
• Underestimated - treat empirically • Sexually active women – Peak 20-30 years old • Incidence rate in primary care approximately 280 per 100,000py Risky behaviour
What are teh risk factors for PID
• As for STIs – Young age – Lack of use of barrier contraception – Multiple sexual partners – Low socioeconomic class • IUCD
Describe the history a examination
Ss
What are the differential diagnosis
Gynaecological
• Ectopic pregnancy
• Endometriosis - more chronic pain
• Ovarian cyst complications - bleeding into it can stretch peritoneum, can rupture and bleed, makes ovary higher risk of torsion
Other
• Functional pain - pelvic pain, chronic pelvic pain can be due to chronic PID or without any evidence of anything wrong in pelvis. May not see anything but woman stil has pain
Urinary
• UTI
Gastro- intestinal
• IBS - on and off abdo pain, pain on opening bowel
• Appendicitis - RIF pain, vomiting, generally more nausea with this than PID
Wha are the investigation
• Urinary and/or serum pregnancy test
• Endocervical and High vaginal swabs - anterior and posterior fornices
– Presence of NG/CT supports diagnosis
– Absence of NG/CT does not exclude diagnosis
• Blood tests
– WBC and CRP- check if treatment is working or not
• Screening for other STIs including HIV
• Diagnostic laparoscopy is gold standard - not done often , unless it is not getting better
– Can also perform adhesiolysis (divide adhesions) and drain abscesses
What are the findings at laparoscopy
Ss
Describe the management
• Low threshold for empirical treatment
– Delayed treatment increases longterm sequelae
• Symptomatic management with analgesia and rest
• Management of sepsis
• Severe disease requires IV antibiotics and admission for observation and possible surgical intervention
– Pyrexia >38, signs of tubo-ovarian abscess, signs of pelvic
peritonitis
– No response to oral therapy
– Increased risk of longterm sequelae
• Contact tracing essential for partners, and full screen for
woman
– GUM best able to do this
What are the treatments
C Antibiotic therapy for 14 days
Cephtrioocne
Describe the surgical management
Laparoscopy/laparotomy may be considered if
– No response to therapy – Clinically severe disease – Presence of a tubo-ovarian abscess
What are the complications
• Ectopic pregnancy • Infertility • Chronic pelvic pain • Fitz-Hugh-Curtis Syndrome – RUQ pain and peri-hepatitis following Chlamydial PID (10-15%) • Reiter syndrome – Disseminated Chlamydial infection
