PID

Question 1

List the microbes commonly implicated in PID

Answer 1

• Neisseria gonorrhoeae
• Chlamydia trichomatis
• Gardnerella vaginalis
• Anaerobes: Prevotella, Atopobium, Leptotrichia
• Mycoplasma genitalium
• E coli
• Aerobic streptococci
• Bacteroides fragilis
• Peptostreptococcus

Question 2

What are the risk factors for PID?

Answer 2

Age <30 years
Multiple sexual partners.
New sexual partner.
Non-condom use.
Sex worker.
Recent IUD insertion.
Recent TOP.
Postpartum.
Upper genital tract instrumentation.

Question 3

What investigation result has good negative predictive value for PID?

Answer 3

Absence of white cells on genital swab Gram-staining.
NPV 95%.
Presence of white cells however is non-specific PPV 17%.

Question 4

First-line outpatient antibiotic regimen for PID treament

Answer 4

IM ceftriaxone 1g or IV cefoxitin 1g stat followed by 2 weeks of oral doxycycline 100 mg BD and metronidazole 400 mg BD.

Question 5

First-line INpatient antibiotic regiment for PID treatment

Answer 5

Ceftriaxone 2g IV daily plus doxycycline 100 mg BD.

At discharge:
Doxycycline 100 mg po BD plus metronidazole 400 mg po BD for 2 weeks

Question 6

INpatient antibiotic regiment for PID treatment if patient has cephalosporin anaphylaxis

Answer 6

Clindamycin 900mg IV TDS plus gentamicin IV once daily

At discharge:
Doxycycline 100 mg po BD plus metronidazole 400 mg po BD for 2 weeks

Question 7

What follow-up should you organise for a patient with PID?

Answer 7

Review 2-4 weeks after antibiotics completed.
Check adequate clinical response.
Check compliance.
Check contact tracing.
Discuss significance of PID and long term sequelae.
Repeat pregnancy test if required.

Question 8

When is a test of cure indicated following PID?

How soon can test of cures be performed?

Answer 8

Indications:

• Persisting symptoms
• Not compliant with antibiotics
• Reinfection concerns

Gonorrhoea: 2-4 weeks after treatment
Chlamydia: 5 weeks after treatment

Question 9

What are the short and long term complications of PID?

Answer 9

Fitz-Hugh-Curtis syndrome.
Ectopic pregnancy.
Infertility.
Chronic pelvic pain.
Pregnancy: maternal and fetal morbidity.