S9) Pelvic Inflammatory Disease Flashcards
What is pelvic inflammatory disease?
- Pelvic inflammatory disease is the infection of the female upper genital tract which ascends from the endocervix
- It presents with endometritis, salpingitis, parametritis, oophoritis, tubo-ovarian abscess and/or pelvic peritonitis
In four steps, describe the pathophysiology of Pelvic Inflammatory Disease
⇒ Ascending infection from the endocervix & vagina
⇒ Infection causes inflammation
⇒ Inflammation causes damage to tubal epithelium
⇒ Adhesions form
What is endometritis?
Endometritis is the inflammation and infection of the endometrium lining of the uterus
What is salpingitis?
Salpingitis is the inflammation and infection of the uterine tubes
they can fill with pus → tube-ovarian abscess
What is parametritis?
Parametritis is the inflammation of the uterine ligaments and parametrium (connective tissue adjacent to the uterus)
What is oophoritis?
Oophoritis is the inflammation of the ovaries, often arising due to infection and often accompanied with salpingitis
What is a tubo-ovarian abscess?
- A tubo-ovarian abscess is an encapsulated pocket of pus which forms due to infection of the fallopian tubes and ovaries
- It is a late complication of PID and can be life-threatening if the abscess ruptures and results in sepsis
What is pelvic peritonitis?
Pelvic peritonitis is the inflammation and infection of the peritoneum, which is the membrane that lines the abdomen in the pelvic area, often occurring as a complication of salpingitis
Identify the two commonest organisms which cause PID as they are the most common infective organisms
Sexually transmitted infections:
- Chlamydia trachomatis
- Neiserria gonorrhoeae
Identify 4 other organisms which commonly cause PID
- Gardnerella vaginalis
- Mycoplasma hominis
- Anaerobes
- Actinomycosis
Which group of people have a high incidence of PID?
Sexually active women (20-30 years old)
Identify 5 risk factors for pelvic inflammatory disease
- Young age
- Lack of use of barrier contraception
- Multiple sexual partners
- Low socioeconomic class
- Intrauterine contraceptive device (IUCD)
Identify 6 symptoms of PID
- Pyrexia
- Lower abdominal pain
- Deep dyspareunia
- Abnormal vaginal/cervical discharge
- Abnormal vaginal bleeding
Describe 5 features observed during the examination of a typical patient with PID
- Fever
- Lower abdominal tenderness (bilateral)
- Lower genital tract infection
- Purulent cervical discharge
- Cervicitis
Provide a differential diagnosis of PID in terms of bladder, bowel and gynaecological conditions respectively
- Bladder conditions – UTI
- Bowel conditions – IBS, appendicitis
- Gynaecological conditions – ectopic pregnancy, endometriosis, ovarian cyst complications
What investigations would one perform to establish the diagnosis of PID?
- Urinary and/or serum pregnancy test
- Endocervical and high vaginal swabs (NG/CT supports diagnosis)
- Blood tests (WBC & CRP)
- Screening for other STIs
- Diagnostic laparoscopy (gold standard)
Briefly outline the management of PID
- Symptomatic management with analgesia and rest
- Management of sepsis
- Severe disease requires IV antibiotics, admission for observation and possibly surgical intervention
Describe the surgical management of PID
Laparoscopy/laparotomy may be considered if:
- No response to therapy
- Clinically severe disease
- Presence of a tubo-ovarian abscess
Identify the 3 antibiotics used for the treatment of PID
- Ceftriaxone
- Doxycycline
- Metronidazole
Identify 5 complications of PID
- Ectopic pregnancy
- Infertility
- Chronic pelvic pain
- Fitz-Hugh-Curtis syndrome
- Reiter syndrome
scarring and adhesion can occur in the reproductive tract as fibrin is usually deposited due to chronic inflammation
what is chlamydia?
- most common STI
- typically asymptomatic
- can cause testicular pain
what is gonorrhoea?
- it is an STI
- gram negative
- diplococci
- 90% men are symptomatic
- thick yellow discharge
what is non-gonococcal urethritis (NGU)
- STI
- inflammation of the urethra
- common in older men
Urine samples are used to test for which STI’s?
- gonorrhoea
- chalmydia
- urethritis
what is a urethral swab used to test for
gonorrhoea
what is Treponema pallidum responsible for causing
- syphilis
- primary syphilis: painless ulcer in genitals, can be infectious but will usually dissapear
- secondary → develop weeks later and show up as a rash
- tertiary → can be latent and reappear randomly can be congenital
what are Anogenital warts
- most common viral STI
- caused by human papilloma virus
- painless warts that will go away by themselves
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what is Herpes simplex virus
- HSV-1 → can cause oral and genital herpes
- HSV-2 → causes genital herpes and often reoccurs can potentially spread to child
- can be treated with anti-virals acyclovir
what is Trichomonas vaginalis
- sexually transmitted protozoa
- men → asymptomatic but can cause dysuria and discharge
- women → vaginal discharge, typically yellow
what’s the main way to test for STIs in men
urine sample: first catch for gonnorhea and chlamidya
what is the main way to test for UTIs in women?
vaginal swab
High vaginal for trichomonas
Endocervical for chlamydia/gonorrhoea
Vulvovaginal (if asymptomatic) for chlamydia/gonorrhoea
what are two non-sexually transmitted diseases
Bacterial Vaginosis (BV)
Vulvovaginal Candidiasis
what is Bacterial Vaginosis (BV)
- non-sexually transmuted disease
- common cause for discharge in women
- pH imbalance of the vagina
- different bacteria start growing
- can be due to Gardnerella vaginalis bacteria
- diagnosed by vaginal swabs and treated with metronidazole
what is Vulvovaginal Candidiasis
- non-sexually transmitted disease
- caused by Candida albicans most commonly
- white non-offensive vaginal discharge with pain
- can diagnose with a swab
- treated with oral azoles
