Women's Health/ Pelvic Inflammatory Disease

Question 1

What is the definition of pelvic inflammatory disease (PID)?

Answer 1

• acute, usually polymicrobial, infection/inflammation of the upper genital tract in women, involving any or all of the uterus, oviducts, ovaries, and pelvic peritoneum

Question 2

How does cervicitis lead to PID?

Answer 2

Through ascending infection by microorganisms

Question 3

What are the most common organisms found to cause PID?

Answer 3

• N. gonorrhoeae
• C. trachomatis
• Mycoplasma genitalium
• anaerobic and facultative organisms
  
  • Prevotella
  • E. coli
  • Haemophilus influenzae
  • group B streptococcus

Question 4

What are some typical signs and symptoms of PID?

Answer 4

• lower abdominal pain (90%)
• mucopurulent cervical discharge (75%)
• fever (50%)
• rebound tenderness
• urethritis
• proctitis
• chills
• abnormal uterine bleeding

Question 5

What are the minimal clinical criteria needed to diagnose PID?

Answer 5

Cervical motion tenderness or uterine or adnexal tenderness in the presence of lower abdominal or pelvic pain

Question 6

What laboratory tests should you perform if you suspect PID in a patient?

Answer 6

• pregnancy test
• microscopy of cervical or vaginal discharge,
• FBC
• gonorrhea/chlamydia tests
• urinalysis

Question 7

What study should you perform if the patient appears acutely ill with a pelvic mass?

Answer 7

Pelvic ultrasound to rule out a tuboovarian abscess (TOA)

Question 8

What are the sequelae of untreated PID?

Answer 8

• ectopic pregnancy
• infertility
• chronic pelvic pain
• recurrent salpingitis

Question 9

What is the name for the syndrome of perihepatitis that occurs in 10% of patients with PID caused by N. gonorrhoeae or C. trachomatis ?

Answer 9

Fitz-Hugh-Curtis syndrome

Question 10

Which patients should you hospitalize for treatment of PID?

Answer 10

• pregnant
• adolescent
• poorly compliant
• immunodeficient
• high fever
• inability to tolerate oral medication due to nausea and vomiting
• TOA
• upper peritoneal signs
• inadequate response to outpatient therapy after 48 hours, uncertain diagnosis

Question 11

What are some recommended outpatient regimens for treatment of PID?

Answer 11

• ceftriaxone 250 mg intramuscularly (IM) × 1 +
• doxycycline 100 mg PO BID for 14 days
• cefoxitin 2 g IM × 1 +
• probenecid 1 g PO × 1 +
• doxycycline 100 mg PO BID for 14 days
• cefotaxime 1 g IM × 1 +
• treat partner(s) also

Question 12

What medication would you add if you suspected PID with T. vaginalis or bacterial vaginosis, a pelvic abscess or history of gynecologic instrumentation in the past 3 weeks?

Answer 12

Metronidazole 500 mg PO BID for 14 days