PID (Pelvic Inflammatory Disease)

Question 1

What is PID and its usual cause?

Answer 1

Inflammation of Uterus, Ovaries and Fallopian Tubes

Ascending infection from Vagina through Cervix

Question 2

What are the 3 organisms that most commonly cause PID?

What’s 1 other cause

Answer 2

• Chlamydiae trachomatis
• Neisseria gonorrhoeae
• Gardnerella vaginalis
• Intra-uterine devices (contraceptives)

Question 3

PID most often affects sexually active women aged 20-30.

What are 4 risk factors

Answer 3

• Young age
• Multiple sexual partners
• Lack of barrier contraception
• Low socio-economic status

Question 4

How does PID present?

Answer 4

• Chronic Lower ab pain
• Dyspareunia
• Discharge
• Vaginal bleeding (Intermenstrual or post-coital)

Question 5

How does PID appear on examination?

Answer 5

• Pyrexia
• Abdominal pain on palpating
• Evidence of discharge on speculum examination
• Bimanual Vaginal examination-> Cervix tenderness/ mass may be palpable if turbo-ovarian abscess is present

Question 6

What are 3 types of non-infective causes of PID?

Answer 6

Urinary;
- UTIs

Gastrointestinal;
- Appendicitis, IBS

Gynaecological;
- Ectopic pregnancy, Ovarian cysts, Endometriosis

Question 7

What are some complications of PID?

Answer 7

• Chronic pelvic pain due to fixed retroverted uterus
• Tubo-ovarian abscess
• Subfertility/ Ectopic pregnancy (Due to scarring in reproductive tract)
• Peritonitis
• “Fitz-Hugh-Curtis Syndrome”
• Disseminated chlamydial infections (Urethritis, conjunctivitis, arthritis)

Question 8

What is Fitz-Hugh-Curtis Syndrome?

Answer 8

• Inflammation of liver capsule-> Peri-hepatitis

- Leads to RUQ pain and Scarring between liver and diaphragm

Question 9

How is PID managed?

Answer 9

• Antibiotics (IV if severe infection)
• Pain relief
• Contact tracing and screening
• Laparoscopy if patient doesn’t respond to antibiotics

Question 10

What is Endometritis?

Is it acute or chronic?

Answer 10

Inflammation of endometrial lining of uterus

Can be both

Question 11

What is Salpingitis?

What structures can it cause long-term damage to?

Answer 11

Inflammation of the Fallopian tubes

Ciliated epithelium of the tubes

Question 12

In Salpingitis, what can happen due to Inflammatory Exudate?

Answer 12

Can cause tubes to fill with pus-> Adhesions and obstruction-> Tubo-ovarian abscesses forming

These normally stay within the tubes but can spread to cause peritonitis