9. PID

Question 1

what is PID

Answer 1

infection of the female upper genital tract ascending from the endocervix to the uterus, uterine tubes, ovaries or pelvic pertioneum, causing inflammation

Question 2

what are infection of the endometrium, uterine tubes, ovaries or pelvic peritoneum called

Answer 2

• endometritis
• saplingitis
• oophoritis
• pelvic peritonitis

Question 3

what are the common causes of PID

Answer 3

1. sexually transmitted infections - often polymicrobial but most involve: Chlamydia trachomatis or Neserria gonorrhoea
2. IUCD

Question 4

what is the typical presentation of someone with PID

Answer 4

1. pyrexia
2. pain: lower abdominal and deep dyspareunia
3. abnormal vaginal discharge/bleeding

Question 5

what is the differential diagnosis for PID

Answer 5

Gynaecological

• ectopic pregnancy
• endometriosis
• ovarian cyst complications

Gastro-intestinal

• IBS
• appendicitis

Urinary

• cystitis
• bladder stones

Question 6

which investigations should be performed in suspected PID

Answer 6

1. swabs: vulvovaginal and endocervical
2. blood tests: WBCs and CRP
3. screening for other STIs inc. HIV
4. ultrasound
5. laparoscopy - can also swab peritoneum, perform adhesiolysis and drain abscesses

Question 7

which antibiotics should be used to treat PID

Answer 7

ceftriaxone, doxycycline and metronidazole (IV if inpatient)

Question 8

when might surgical management be considered and what does this consist of

Answer 8

laparoscopy or US-guided aspiration may be considered if:

• no response to therapy
• clinically severe disease
• presence of a tubo-ovarian abscess

may help early resoltion by dividing adhesions and draining pelvic abscesses

Question 9

what are the possible complications of PID

Answer 9

1. chronic recurring infection
2. chronic pelvic pain
3. infertility or ectopic pregnancy due to adhesions
4. tubo-ovarian abscess - potentially life-threatening due to sepsis from rupture