PID/pelvic infection Flashcards
What is PID? What are the two main organisms responsible for PID?
Pelvic inflammatory disease - an acute, ascending infection of upper female genital tract. Main causes - Neisseria gonorrhoea and Chlamydia trachomatis
Name 3 risk factors for PID
Unprotected sexual activity with multiple partners
Previous Hx of STIs or PID
IUD insertion
Name 4 common symptoms of PID
Bilateral pelvic pain
N&V
Deep dyspareunia
Abnormal vaginal bleeding or discharge
Name 5 findings on examination consistent with PID. Which is the most sensitive sign?
Temp > 38
Lower abdominal tenderness
Discharge on vaginal examination
Purulent exudate on endocervix on speculum examination
Cervical excitation, uterine tenderness and/or adnexal tenderness on bimanual examination - most sensitive
Name 4 initial investigations to order for PID and expected results
FBE - elevated WCC
Wet mount of vaginal secretions - PMNs present
ESR - elevated
PCR or culture of vaginal secretions for Neisseria gonorrhoea and chlamydia - if +ve, 100% specificity for PID (but not all PID will be +ve)
What effect does an IUD have on the incidence of PID? What organism is associated with IUD-related PID?
Doesn’t increase incidence, but makes any infection worse
Associated with actinomyces (but need to distinguish b/w colonisation and infection)
Name 4 complications of PID. What organism is most closely associated with these complications?
Ectopic pregnancy (can cause adhesion around fallopian type) Hydro/pyosalpinx - fallopian tube filled with fluid/pus from distal obstruction Tubo-ovarian abscess Fitz-Hugh-Curtis syndrome (perihepatitis from peritoneal spread of organisms to capsule of liver)
Chlamydia more likely to cause complications
What is the usual empirical management of mild-moderate PID?
Stat oral azithromycin and IM/IV ceftriaxone + 14 days of oral metronidazole + either 14 days oral doxycycline, or another stat dose of oral azithromycin 1 week later (if pregnant or non adherent to doxycycline)
Contact tracing
Consider removal of IUD
What is the empirical management of severe PID?
IV ceftriaxone/cefotaxime + oral azithromycin or IV metronidazole
What is cervicitis? What usually causes it?
Inflammation of cervix - can be infectious (usually chlamydia or gonorrhoea) or non-infectious
How does cervicitis usually present? Name 2 Ddx for this presentation. Name 2 other symptoms of cervicitis
Post-coital bleeding. Other causes - ectropion, or cervical Ca. Other symptoms - purulent vaginal/cervical discharge, dysuria and increased urinary frequency
What is the most sensitive sign on examination for cervicitis?
Easily induced cervical bleeding (‘friable’)
Name 3 investigations if suspicious of cervicitis
FBE - elevated WCC
Wet mount of cervical discharges - raised LMNs
NAAT of vaginal or cervical swabs for chlamydia and gonorrhoea
Pap smear and colposcopy - exclude Ca
What is vaginitis? Name 3 separate etiological causes of the disease, and risk factors for each of these causes.
Inflammation of vagina
Infection
Bacterial vaginosis - multiple sexual partners
Candidiasis - risk factor: high oestrogen, previous antibiotics
Chemical irritation (soaps, sweat from tight clothing, laundry powder) - risk factor: poor/excessive vulval care
Hormonal deficiency (atrophic vaginitis from decreasing oestrogen levels) - risk factor: menopause
Name 3 common symptoms of vaginitis
Vaginal discharge, dysuria, itching, dyspareunia
