S9.2 Pelvic Inflammatory Disease

Question 1

What is PID?

Answer 1

The result of infection ascending from the endocervix

Question 2

What 3 things occur to the female reproductive tract as a result of PID?

Answer 2

Endometritis - inflammation of endometrium

Salpingitis of fallopian tube, exudate fills tube with puss, can block tubes

Tubo-ovarian abscess - neutrophils and macrophages infiltrate leading to exudate then abscess

Question 3

What causes PID?

Answer 3

Majority by Chlamydia trachomatis and N. Gonorrhoea.

Can also be caused by Gardnerella vaginalis, Mycoplasma, anaerobes and actinomycosis from copper coil insertion.

Question 4

Describe the epidemiology of PID

Answer 4

Lots asymptomatic, sexually active women 20-30 years old

Question 5

What are some risk factors for PID?

Answer 5

Young age
No condom
Many partners
Intrauterine device

Question 6

What are the clinical features of PID?

Answer 6

History: pyrexia, lower abdominal pain, dyspareunia, abnormal discharge
Examination: fever, lower abdominal tenderness, cervical discharge

Question 7

List some differentials for PID

Answer 7

UTI
IBS
Appendicitis
Ectopic pregnancy

Question 8

What investigations should you performs for PID?

Answer 8

Serum pregnancy test
Endocervical swab
Bloods: WCC, CRP
Laparoscopy

Question 9

Describe the management for PID

Answer 9

Antibiotics

Cetriaxone, doxycycline, metronidazole

Question 10

What are some complications of PID

Answer 10

Ectopic pregnancy
Infertility
Fitz-Hugh-Curtis syndrome: RUQ pain and peri-hepatitis following Chlamydial PID
Reiter’s syndrome