PID Flashcards
PID encompasses what types of infection?
Endometritis Salpingitis Oophoritis Parametritis Peritonitis TOA
Ascending infection from the endocervix
Sequelae of PID
Infertility
Ectopic
CPP
Clinical features of PID
B/L lower abdominal tenderness Abnormal vaginal or cervical discharge Fever >38 Abnormal vaginal bleeding (intermenstraul, postcoital or breakthrough) Deep dyspaerunia CMT Adnexal tenderness
Outpatient treatment of PID
250mg IM ceftriaxone
Oral doxy 100mg BD 14/7
Metronidazole 400mg BD for 14/7
OR
Ceftriaxone
Azithro 1g/week for 2 weeks
Info to give patients
Explanation of treatment and adverse effects
Potential for infertility, CPP, or ectopic
Repeat episodes of PID are associated with an exponential increase in the risk of infertility
Use barrier contraception
Screen sexual contacts/contact tracing
Clinically more severe disease is at greater risk of sequelae
The earlier treatment is given the lower the risk oof future fertility problems
Admit to hospital if
Surgical emergency not excluded Clinically severe disease TOA PID in i pregnancy Lack of response to oral therapy Intolerance to oral therapy
Inpatient treatment regime
Ceftriaxone 2g IV daily Doxy 100mg PO BD Metro 400mg PO BD OR Clinda IV 900mg TDS plus gent(smo/kg load then 1.5mg/kg TDS) followed by Clindamycin 450mg 4x daily 14/7 oral OR if pregnant - Cefotaxime, azithro and metro for 14/7
When to remove IUD
To consider, especially if symptoms not resolved within 72 hours
If actinomyces on smear and has pelvic pain
Requested by patient
Risk factors for PID
Previous STI Previous PID 16-24 yo (5x higher risk) Vaginal douching Smoking Low SES Recent IUD (w/in 4/52) Recent intrauterine procedure Lots of partners No barrier contraception or inconsistent Sex during or just after menstruation Genetic factors may play a role
Bacterial aetiology of PID
Gonorrhoea
Chlamydia
Gardernella
Anaerobes
Other possibles:
Mycoplasma genitalium
Ureaplasma
Investigations
Preg test Swabs CBC, CRP Electrolytes, LFTs, and coag if systemic bacteraemia MSU
USS sensitivity and specificity of TOA
90%
May show FF and site-specific tenderness
Doppler can identify inflamed and dilated tubes and TOAs
Risk of ectopic pregnancy and infertility after 1 and 2 episodes
6x increased risk
17x after 2
*single treated chlamydia doe not increase risk of ectopic, but RR increases to 11 after 3 episodes of chlamydia infection
Fits-Hugh Curtis syndrome
RUQ pain associated with perihepatitis
