Simulation Case PID - Pearson Flashcards
What is important patient history questions given presentation of female pelvic pain?
OPQRSTa
Fever/Chills, N/V
Sexual History
Vaginal Bleeding/Discharge
Urinary symptoms
What is DDx for female pelvic pain?
Appendicitis Ectopic Pregnancy Cystitis/UTI/nephrolithiasis Ovarian cyst, torsion Endometriosis Gastroenteritis/IBS/IBD PID: Endometritis, Parametritis, Salpingitis, Oophoritis, TOA, Peritonitis
What are the Sx of PID?
Lower abdominal or pelvic pain Fever Vaginal discharge or bleeding Vaginal itching or odor Dyspareunia Back pain Nausea or vomiting Remember----Sometimes very minimal symptoms!
What are risk factors for PID?
Age
What are the clinical diagnostic criteria for PID?
1) 1+ of the following minimal criteria must be present on pelvic exam to diagnose PID:
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
2) Plus one or more of the following will enhance diagnostic specificity:
Oral temp >101° F (>38.3° C)
Abnormal cervical mucopurulent discharge or cervical friability
Abundant numbers of WBC on saline microscopy of vaginal fluid
Elevated ESR
Elevated CRP
Positive testing for N. gonorrhoeae or C. trachomatis
How is PID usually diagnosed?
Diagnosis is made clinically!
Labs and imaging for cases with uncertain diagnosis, failure to respond to therapy, or have severe illness
Spectrum ranges from asymptomatic to life threatening!
When should you consider inpatient treatment for a patient with PID?
Unable to follow treatment plan or take oral therapy Severely ill Surgical abdomen Tubo-ovarian abscess No improvement after 72 hours Pregnancy
What is the recommended treatment for PID?
CDC-recommended oral regimens:
Ceftriaxone IM in a single dose + Doxycycline orally for 14 days (With or Without Metronidazole orally for 14 days)
OR:
Cefoxitin IM in a single dose and Probenecid orally in a single dose, PLUS Doxycycline orally for 14 days
(With or Without Metronidazole orally for 14 days)
Parenteral only: Clinadmycin IV PLUS Gentamicin IV
What are the causes of PID?
Commonly includes Chlamydia trachomatis, Neisseria gonorrhoeae, and aerobic and anaerobic vaginal flora
(CMV, M. hominis, U. urealyticum and M. genitalium may be associated w/ some cases)
What are the potential sequelae (or complications) of PID?
20% chance of developing infertility from tubal scarring
9% chance of having an ectopic pregnancy
18% chance of developing chronic pelvic pain
What is a Tubo-Ovarian Abscess?
Complication of PID: “Pus from the fallopian tube spills into ovary and infects it at the site of follicular rupture”
What is the treatment for a Tubo-Ovarian Abscess?
***Surgical Drainage + Antibiotics
- Rupture of TOA markedly decreases future fertility
- Laparoscopic drainage is essential (either in ruptured or non-ruptured TOA) in helping preserve future fertility
What is the recommended follow up for women with PID?
- no improvement with Tx after 72 hrs
- re-screening for C. trachomatis and N. gonorrhoeae 3 months after completion of therapy
- potential HIV testing
Who should be annually screened for chlamydia?
Sexually active women 25 and under
Sexually active women >25 at high risk
Screen pregnant women in the 1st trimester
Should sexual partners be treated in the setting of PID?
Male sex partners of women with PID should be examined and presumptively treated if they had sexual contact with the patient during the 60 days preceding the patient’s onset of symptoms.
If last sexual partner was >60 days before onset of symptoms, the most recent sexual partner should be treated.
