PID

Question 1

what is PID

Answer 1

A bacterial infection that spreads beyond the cervix to the upper female reproductive tract and or peritoneal cavity

Question 2

what can PID cause (7)

Answer 2

1. Endometritis
2. Salpingitis
3. pyosalpinx/ hydrosalpinx
4. Oophoritis
5. tuboovarian abscess
6. Parametritis
7. Peritonitis.

Question 3

what are common causes of PID (2)

Answer 3

1. Chlamydia trachomatis
2. Neisseria gonorrhoeae.

Question 4

what are other causes of PID (3)

Answer 4

1. E.coli
2. ureaplasma
3. mycoplasma

Question 5

what are clinical features of PID (10)

Answer 5

1. Pelvic pain – which may progress to an acute abdomen
2. Adnexal tenderness on bimanual palpation
3. Cervical motion tenderness
4. Fever
5. Abnormal vaginal discharge
6. LAP
7. Dyspareunia
8. dysuria
9. nausea and vomiting
10. irregular menstrual bleeding ( HMB, PCB, spotting)

Question 6

what are risk factors for PID (7)

Answer 6

1. Multiple sexual partners
2. unprotected sexual intercourse
3. History of prior STIs
4. Intrauterine devices
5. Vaginal dysbiosis
6. new sexual partner
7. Douching

Question 7

what is a common triad for PID

Answer 7

1. LAP
2. Adnexal tenderness
3. cervical motion tenderness

Question 8

Besides the normal triad for PID diagnosis what other things can accompany the triad (6)

Answer 8

1. Temp> 38.3
2. Purulent material in the pouch of douglas
3. abnormal vaginal discharge
4. Leukocytosis
5. pelvic mass - tubo-ovarian abcess
6. positive test for gonorrhea and chlamydia

Question 9

what is a ddx for PID (8)

Answer 9

Gynecological
1. ectopic pregnancy
2. ovarian cyst rupture
3. ovarian torsion
4. endometriosis

Non-gynecological
1. Appendicitis
2. Kidney stones
3. IBS
4. diverticulitis

Question 10

what investigations can you do (4)

Answer 10

1. Pregnancy test- to rule out intrauterine/ ectopic pregnancy
2. Blood tests
   - HIV testing, RPR for syphilis
   - FBC
   - ESR
3. Imaging: Transvaginal USS
4. Vaginal and/or cervical swab testing NAAT and/or culture for N.gonorrhoeae and C. trachomatis

Question 11

what is the gainesville classification of acute PID (5)

Answer 11

Stage 1
- endometritis, salpingitis, no peritonitis
Stage 2
- acute salpingitis with peritonitis
Stage 3
- acute salpingitis with either tubal occlusion/ tubo-ovarian complex/abscess
Stage 4
- rupture of tubo-ovarian abscess
Stage 5
- associated with respiratory complications

Question 12

what are the goals of PID treatment (5)

Answer 12

Stage I:
Eliminate symptoms and infectivity
Stage II:
Preservation of fallopian tube function
Stage III:
Preservation of ovarian function
Stage IV:
Preservation of patient’s life

NB : Stages I and II is treated conservatively with antibiotics while stages III to V is by laparotomy

Question 13

what is the treatment of PID (4)

Answer 13

1. Gentamycin 240mg IM x1
2. Doxycline 100mg q12hours x14 days
3. Metronidazole 400mg q8 hours x14 days
4. Also treat partner with gentamycin and doxycline

Question 14

If not improved within 72 hours, not tolerating oral intake, signs of sepsis, or pelvic mass, what inpatient treatment do you give (2)

Answer 14

• Gentamycin 1.5mg/kg IV or IM q8 hours
• Clindamycin 900mg IV q8 hours

Question 15

what are short term complications of PID (3)

Answer 15

1. Pelvic peritonitis
2. Fitz-Hugh syndrome- RUQ (violin string like adhesions)
3. Tubo-ovarian abscess

Question 15

what are indications for surgery (4)

Answer 15

1. A proven tubo-ovarian abscess on ultrasound
2. A ruptured tubo-ovarian abscess
3. A patient still not improving on conservative management
4. A patient in septic shock

Question 16

what are long term complications of PID (3)

Answer 16

1. Infertility
2. Ectopic pregnancy
3. Chronic pelvic pain- Intestinal adhesions between bowel and pelvic organs/ tubal adhesions/ ovarian adhesions

Question 17

what causes fitzs Hugh Curtis syndrome

Answer 17

Purulent materials spills from tubes into abdomen directly or lympatically

Question 18

what is Fitz hugh curtis syndrome

Answer 18

bacterial perihepatitis

Question 19

what is usually normal in Fits-Hugh-Curtis syndrome

Answer 19

LFTs

Question 20

what symptoms are found in fitz hugh curtis syndrome (2)

Answer 20

• RUQ
• shoulder pain

Question 21

when doing a laparatomy what do you if there is fitz hugh curtis syndrome

Answer 21

violin string like adhesions