PID

Question 1

What is PID?

Answer 1

The result of infection ascending from the endocervix, causing endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis

Question 2

Outline the pathophysiology of PID

Answer 2

Ascending infection from endocervix/vagina = inflam = damaged tubal ep = adhesions

Question 3

What is salpingitis?

Answer 3

Inflam of fallopian tubes

Forms inflammatory exudate = fills tubes with pus = adhesions/fibres = blocks = forms abscess

Question 4

What is a tubo-ovarian abscess?

Answer 4

Inflammatory mass involving the fallopian tube, ovary, occasionally adjacent pelvic organs

Late complications of PID

Can rupture and result in sepsis

Question 5

Outline the aetiology of PID

Answer 5

Gonorrhoea

Chlamydia (doesn’t have a cell wall, so you cant gram stain it, detected by PCR)

Question 6

What are the risk factors for PID?

Answer 6

Young age 15-24

Lack of barrier contraception

Multiple sexual partners

Low socioeconomic class

Hx of STIs

Question 7

What are the features of a PID Hx?

Answer 7

Pyrexia

Pain = Lower abdominal pain, Deep dyspareunia

Abnormal vaginal/cervical discharge

Inter-menstrual and/or post-coital bleeding

Sexual history and prior STI

Contraceptive history = no barrier

Question 8

What clinical features are seen in a PID examination?

Answer 8

Fever

Low abdo tenderness

Bimanual examination = cervical motion tenderness, bilateral adenexal tenderness

Speculum exam = low genital tract infection, discharge, cervicitis

Question 9

Outline the Ix that should be performed for PID

Answer 9

Preg test

Endocervical/high vaginal swabs = diff locations of MOs
- tested via NAAT

Blood tests = WBC, CRP

Screening for other STIs

Urine dip +/- MSU

Diagnostic laparoscopy

USS

Question 10

Outline the management of PID

Answer 10

Symptomatic treatment with analgesia and rest

Management of sepsis

Severe = broad IV Abx, possible surgical intervention (laparoscopy/laparotomy)

• doxycycline, ceftriaxone, metronidazole
• ofloxacin and metronidazole

Contact tracing

Question 11

What complications occur due to PID?

Answer 11

Ectopic preg

Infertility = due to scaring

Chronic pelvic pain = fixed retroverted uterus by scaring pulling it backwards

Fits-hugh-curtis syndrome = RUQ pain, adhesions between liver and diaphragm following chlamydial PID

Reiter syndrome = (cant see, cant pee, cant bend at the knee) disseminated chlamydial infection

Tubo-ovarian abscess

Question 12

What is endometritis?

Answer 12

Inflam and infection of the endometrium