PID

Question 1

def of PID

Answer 1

Subacute to Chronic infectious disease of the female reproductive tract (excluding vagina or vulva) and
Inflammation of the female pelvic structures.

d/2 ascending spread of infec from cervix-
uterus-fallopian tubes , ovaries and adjacent peritoneum.

Question 2

Acute PID vs chronic

Answer 2

ACUTE	
generalised symptoms
Lasts a few days
May recur in episodes
Very infectious in this stage

CHRONIC
Patient may have no symptoms
Occurs over months and years
Progressive organ damage

Question 3

what is the classic pt w/ PID

Answer 3

Promiscious young woman of reproductive age ,
unprotected sex ,
multiple partners

Question 4

etiology

Answer 4

85 – 95% is due to specific sexually
transmitted organisms( Gonorrhea, Chlamydia)

5 – 15% begins after reproductive tract
trauma

Endogenous infection from commensal organisms

Tuberculosis (TB)

Question 5

specific sexually

transmitted organisms causing PID

Answer 5

o Neisseria gonorrhoea

o Chlamydia trachomatis

Question 6

examples of reproductive damage causing PID

Answer 6

o From pregnancy
o From surgical procedures e.g. D&C
o Insertion of IUCD= assac w/ Actinomycosis

Question 7

examples of commensal organisms casing PID

Answer 7

o Anaerobes e.g. Bacteroides
o Aerobes e.g. E Coli, Streptococcus
species
o Actinomycosis with IUCD

Question 8

RF for PID

Answer 8

eatly Age of 1 st intercourse

increae w/ increaing Number of sexual partners

Number of sexual contacts by the sexual partner

Cultural practices

Polygamy,

Prostitution

 Frequency of
intercourse (Age)

IUCD

Poor health resources

Antibiotic exposure
(resistance)

Question 9

pathogenesis of PID (?)

Answer 9

1. a procedure break cervical mucous barrier occurs
   Once cervical barrier is broken many other organisms can get access to upper reproductive tract
2. adult vagina is lined by stratified squamous epithelium like skin but the cervix has simple columnar epithelium that contains mucous-secreting cells receive sperm
3. Organisms can access higher when mucous is receptive like in cervix
4. Endometrium sheds regularly so is infrequently a site of chronic infection
5. Fallopian tubes and peritoneum should be sterile So rarely a site of a infection but in PID inflammation causes reduced motility and pyosalpinx
   complications: peritonitis, perihepatitis

Question 10

most common sx of PID

Answer 10

lower abdominal pain

Question 11

describe the lower abdominal pain in PID

Answer 11

o Dull and crampy
o Bilateral
o Associated w/ menstruation (cyclical)
o Begins few days after period

Question 12

What is the dx for lower abdomina pain assoc w/ menstruation

Answer 12

endometriosis

adenomyosis

Question 13

other sx of PID

Answer 13

Mucopurulent discharge

Fever

Postcoital vaginal discharge – inflammation-trauma from sexcual intercourse-spotting

Painful intercourse

Irregular menstruation

Question 14

physical exam of PID

Answer 14

o Cervical motion tenderness
– aka chandallier sign!! useful n acute abdomen

o Uterine tenderness - most sensitive

o Adnexal tenderness
- a lump in tissue of theadnexaof uterus
—————at least 1/3 above is mandatory————

o Mucopurlent discharge

o Fever over 38 degrees

o positive gonorrhoea or chlamydia

o WBC on wet mount

o RUQ – Fitz Hugh Curtis syndrome
-rare complication ofinvolving liver capsule inflammation leading to the creation of adhesions.

Question 15

what is Fitz Hugh Curtis syndrome

Answer 15

perihepatic inflammation (d/2 liver capsule inflam) and
adhesions.

presents in 10% of acute PID pts.
It causes RUQ and pleuritic pain

often incorrectly diagnosed as cholecystitis and pneumonia resp.

Question 16

dg of PID

Answer 16

when a pt at risk presents w/ following 
o Lower abdominal pain (90%)
o Fever (sometimes with malaise, vomiting)
o Mucopurulent discharge from cervix
o Pelvic tenderness
o History of STD

Pelvic exam!! most important
Positive chandelier sign: Extreme pain with bimanual pelvic exam. and adnexal mass

Question 17

dg tests to confirm suspicions of PID

Answer 17

o Raised WCC
o Endocervical swab for organisms or PCR
o Ultrasound evidence of pelvic fluid collections also excludes appendicitis
o Laparoscopy

Preg test for dx

Question 18

rx of PID

-recovery expected in 3 days

Answer 18

antibiotic
-Needs appropriate spectrum of activity (swab)
- treat sexual partners also 
surgical
• Drain abscess
• Selective or radical removal

rest and analgesic
-NSAID’s

If no recovery in 3 days hospitalize and assess regimen + consider diagnostic laparoscopy

Question 19

Indications for hospitalisation

Answer 19

Hospitalise patients if:
Pregnant
Don’t recover in 3 days
HIV pt
Clinically severe form
–Tubo-ovarian abscess – needs to be drained – Abxs will not penetrate wall if present - assoc w/ HIV
When acute appendicitis cant be excluded as diagnosis

Question 20

AB in PID caused by Gonorrhoea

Answer 20

Cephalosporins, quinolones

Question 21

AB in PID caused by Chlamydia

Answer 21

Doxycycline, erythromycin + quinolones

Question 22

AB in PID caused by Anaerobic organisms

Answer 22

Metronidazole

Question 23

AB in PID caused by hemolytica strep + E.coli

Answer 23

Tetracycline and gentamycin

Question 24

PID IN PREG

Answer 24

• Augmentin or Erythromycin

Hospitalization

Question 25

PID W/ HIV

Answer 25

Hospitalization and i.v. antimicrobials
- More likely to have pelvic abscesses
- Respond more slowly to antimicrobials
-Require changes of antibiotics more
often
-Concomitant Candida and HPV infections

Question 26

complications of PID

Answer 26

chronic pelvic pain

ectopic pregnancy

infertility

reoccurrencee of acaute PID

male genital diseases

Fitz-Hugh-Curtis syn