Repro 6.2 pelvic inflammatory disease

Question 1

What is PID?

Answer 1

the result of infection ascending up from the endocercix

Question 2

What can be seen in PID?

Which of these are common? **

Answer 2

• endometritis **
• salpingitis **
• parametritis
• tubo-ovarian abscess **
• oophritis
• pelvic peritonitis

Question 3

What is endometritis?

Answer 3

Inflammation of the lining of the uterus.

Exudate may be formed.

Question 4

What is salpingitis?

Answer 4

Inflammation / infection of the uterine tubes.

Question 5

What can be some complications associated with salpingitis?

Answer 5

adhesions forming, the tube could get fused to the side wall.
tubo-ovarian abscess(due to exudate getting trapped in the uterine tube)

Question 6

What organisms commonly cause PID?

Answer 6

• Chlamydia trachomatis
• neisseria ghonorrhoea

less common include anaerobes (such as those cuasing bacterial vaginosis) and mycoplasma

Question 7

What are the main complications associated with PID?

Answer 7

• ectopic pregnancy
• infertility
• power pelvic pain
• perihepatitis (Fitz-Huhgh-Curtis syndrome)

Question 8

How do infertility and ectopic pregnancy’s occur from PID?

Answer 8

inflammation and infection lead to adhesions, particulalry in the uterine wall. This leads to decrease motility of hte ovum, of if the egg is fertilised it may not be able to get down to the uterus so an ectopic pregnancy may result.

Question 9

Do you always get symptoms with PID?

Answer 9

No, many cases are asymptomatic, so the prevelance is thought to be underestimated.

Question 10

Who is the most at risk of PID?

Answer 10

sexually active women between the ages of 20-30.

• those who have many partners (unprotected)
• lower socio-economic class
• sex at a young age

people with an IUCD. (copper)

Question 11

What is the incidence of PID?

Answer 11

280 per 100,000 people.

NOT UNCOMMON

Question 12

What symptoms do people experience when they have PID?

Answer 12

• pelvic pain
• dyspanureia
• abnormal disharge
• post-coital bleeding
• pyrexia

Question 13

What might you find on examination of a patient with PID?

Answer 13

• cervical motion tenderness
• may see cervical exudate/inflammation
• fever (>38)
• tenderness of the igaments and tubes of the uterus. (adnexal tenderness)

Question 14

How would you examine somone who you suspected had PID?

Answer 14

bimanual examination

• temperature
• speculum examination

Question 15

How do you carry out a binmanual examination?

Answer 15

place 2 fingers into the vagina and feel for the cervix, and use the other hand to press down on the abdomen.

Question 16

If someone presented with pelvic pain, what could be some differential diagnoses?

Answer 16

• UTI
• pregnancy (ectopic)
• endometriosis
• PID
• STI
• IBS
• Appendicitis?
• Ovarian cyst complications eg rupture.

Question 17

What investigations would you do if you suspected PID?

Answer 17

-pregnancy test
-blood test (CRP, WBC)
endocervical and high vaginal swabs (culture/stain/antigen testing to discover which pathogen is cause)
-screen for other STI’s

Question 18

With regards to swabs of a suspected PID patient, what does it mean if you found CT/NG?
What about if you didnt find CT/NG?

Answer 18

• if found- supports diagnosis

- if not found-does not exclude diagnosis as there are other causes of PID.

Question 19

How do you manage someone with PID?

Answer 19

• empirical treatment (Early broad spectrum antibiotics, delay has been shown to increase chance of complications)
• may require IV antibiotics, admission to hospital and/or surgical intervention
• contact tracing (try to pick up more cases and treat)
• education on safe sex.

Question 20

What antibiotics would you give an outpatient with PID?

Answer 20

• IM ceftriaxone
• PO doxycycline
• PO metroniadazole

Question 21

What antibiotic treatment would you give to an inpatient with PID?

Answer 21

• IV ceftriaxone
• IV doxycycline
• IV metroniadazole

when they are released prescribe oral doxycycline and metroniadazole.

Question 22

What surgical interventions may be used for PID?

Answer 22

Laparoscopy

ultrasound guided aspiration of pelvic fluid collection.

Question 23

When would laparoscopy be considered in someone with PID?

Answer 23

• if they dont respond to treatment
• if its a clinically severe disease
• if there is a tubo-ovarian abscess.

Question 24

What do you need to tell a patient with PID?

Answer 24

• the diagnosis
• the cause, and educate to prevent recurrence
• the possible complications
• the importance of finishing the antibiotics, and the possible side effects
• the need to not have intercourse until antibiotics are complete
• empirical antibiotic treatment of partners (more than likely will also have disease.
• contact tracing to try and treat more people