PID

Question 1

What is the definition of pelvic inflammatory disease?

Answer 1

Acute community acquired infection of the female genital tract

Question 2

What is another name for PID?

Answer 2

ASO-acute salpingo-ophoritis

Question 3

Is PID more common in the developing or developed world?

Answer 3

Developing

Question 4

What are the 7 risk factors that lead to the increased risk of PID?

Answer 4

1. Started sex early
2. Multiple sexual parters
3. New sexual partner
4. Current STI-gonorrhea and chlamydia or bacterial vaginosis
5. Poor socio-economic background
6. Young women<25
7. Sex during menstruation

Question 5

What is the pathophysiology of PID?

Answer 5

1. Primary- ascending infection usually from STI and ascends up cervix (chlamydia trachomatis, Nesseira gonorrhea, gordorella vaginalis

Question 6

What is the secondary pathophysiology of PID?

Answer 6

1. Secondary co-infection-Commensal vaginal flora

- lactobacillus, streptococcus, staphylococcus aureus, anaerobes, enterobacteria

Question 7

What are the protective mechanisms of the female genital tract?

Answer 7

1. Vulva
   -appositional labia
   -fungicidal
   -rich blood supply causing increased WBC
2. Vagina
   -low ph
   -commensal flora
   -stratified squamous epithelium
3. Cervix
   -mucus plug
4. Uterus
   Menses

Question 8

How do we clinically diagnose PID?

Answer 8

1. Triad of findings
   - lower abdominal pain
   - cervical excitation tenderness
   - uterine/Adnexal tenderness

With one of the following:

• pyrexia>38,3
• purulent mucus discharge
• elevated CRP
• ESR>15mm/hour
• signs of infection: elevated WBC

Question 9

What is the differential diagnosis for PID?

Answer 9

1. Obstetric/Gynaecological
   - ectopic pregnancy
   - torsion of ovarian cyst
   - rupture of ovarian cyst
   - endometriosis
   - dysmenorrhea
2. GIT
   - appendicitis
   - inflammatory bowel disease
   - gastroenteritis
   - cholecystitis
3. Uro
   - cystitis
   - pyelonephritis
   - renal stone

Question 10

What is an indication of a turbo-ovarian abscess?

Answer 10

An ESR> 60mm/hour

Question 11

What special investigations do we do for PID?

Answer 11

1. Pregnancy test-to exclude ectopic
2. FBC
3. ESR and CRP
4. HIV and STI
5. Papsmear

Question 12

What is the Fitz Hugh Curtis Syndrome?

Answer 12

Peri-hepatitis-chronic manifestation of PID that leads to inflammation of the liver capsule

Question 13

How do we prevent PID?

Answer 13

1. Sexual habits
2. Condoms and contraception
3. F/U and warning signs

Question 14

What is the classification we use for PID?

Answer 14

Gainesville classification

Question 15

What AB do we give for stage 1?

Answer 15

1. Ceeftriaxone 250mg bd IM
2. Doxycycline 100mg bd four 2 weeks
3. Metronidazole 40omg bd for 2 weeks

Question 16

What AB do we give for stage 3/4 (Triple therapy)

Answer 16

1. Ampicillin 1g 6 hourly
2. Doxycycline 5mg/kg daily IV
3. Metronidazole 500mg 8 hourly

Question 17

When do we do laparotomies?

Answer 17

1. > 40 years
2. Recurrent PID
3. Tubular ligation
4. Has an acute abdomen

Question 18

When do we do laparoscopy?

Answer 18

1. When we find to find the diagnosis
2. When the patient does not respond to AB in 48/72 hours
3. Failed medical treatment

Question 19

What are the sequalae of PID?

Answer 19

1. Recurrence of PID-25%
2. Ectopic pregnancy
3. Infertility
4. Chronic pain
5. Psychological sequalae
6. Mortality-sepsis