PID

Question 1

What is PID?

Answer 1

-Its an ascending infection of the female upper genital tract- above the cervix
Which maybe acute or chronic.

• The spectrum of disease include:
• Endometritis
• Salpingitis
• Oophoritis
• Tubo-ovarian Complex/abscess
• local or generalised peritonitis

Question 2

What are the Risk Factors of PID?

Answer 2

1. Early sexual debut
2. High numbers of sexual partners.
3. Low parity.
4. Presence of Bacterial Vaginosis
5. Previous PID/STI
6. IUD can increase the risk of PID in the short term.
7. Age <25 y/o
8. Concomitant STI

Question 3

What is acute PID?

Answer 3

• Can also be called acute salpino-oophoritis.
• Acute PID affects women of reproductive age
• It is sexually transmitted

Question 4

What is Chronic PID?

Answer 4

-Could be an end result of acute PID

-Adhesions and fibrosis from the acute episode can lead to:
severe distortion of pelvic anatomy
resulting in a frozen pelvis.

-Diagnosis is usually made at surgery

Question 5

What is the pathogenesis of PID?

Answer 5

1. Primary Invasion of bacteria
   - Infection starts in the lower genital tract
   - Where primary invaders are introduced
   - Via sexual intercourse

• Primary invasion may also manifest shortly after menstruation
• After insertion of an IUCD
• After uterine curettage
• Hysterescopy
• Hysterosalpingogram

Question 6

Name the 3 most common primary invaders of PID:

Answer 6

1.Chlamydia Trachomatis

{azithromycin}

2. Neisseria Gonorrhoea

{ceftriaxone}

3. Anaerobes
   * Mycoplasma Hominis
   * Gardnerella Vaginalis

Question 7

What happens in secondary invasion?

Answer 7

• Secondary invasion occurs usually by normal vaginal flora (anaerobes and gram-negative organisms)
• The disease causes progressive inflammation, swelling and hyperaemia (an excess of blood in the vessels supplying an organ) of the fallopian tubes.
• The inflammation impairs the mobility of the tubes
• and causes tubal adhesions to surrounding structures

-In more severe cases the tubal ostia become occluded
-Pelvic peritonitis occurs
-And a pyosalpinx/
Tubo-ovarian complex is formed

-If the complex ruptures into the peritoneal cavity, it causes generalised peritonitis.