PID?
includes acute salphingitis ( gonococcal or nongonoccal)
- IUD related pelvic cellulitis
- tubo-ovarian abscess
- pelvic abscess
what organisms are associated w/ PID?
polymicrobial upper genital infx (mixed aerobic and anaerobic)
- gonorrhea
- chlamydia
- endogenous organisms (H. flue, enteric gram neg rods, streptococci, mycoplasma genitalium)
who normally gets PID?
young, sexually active, reproductive age wome
RF for PID?
sexually active, multiple partners, douching, smoking
what are complications of PID?
inferitlity and ectopic prego
infertility risk?
10% after 1st episode, 25% after 2nd episode, 50% after 3rd episode
Clinical features of PID
-lower abdominal and pelive pain (bilateral
-N (+/- V)
-HA
-lower back pain
+/- fever
PE will show?
lower abdominal and pelvic pain,
- cervical motion tenderness (Chandelier sign)
- purulent discharge and inflammation of Bartholin or Skene gland
what is the chandelier sigh?
cervical motion tenderness
what would a adnexal mass indicate?
tubo-ovarian abscess
lab studes for PID
DNA probe for gonorhea/chlamydia (most common cause)
imaging for PID
transvaginal US is helpful in differentiating acute and chronic inflammation or in the prexence of adnexal mass
-culdocentesis or laproscopy may be required
culdocentisis
peritoneal fluid obtained from the culde sac
tx of mild PID
- outpatients w/ abx, atipyretics, analgesics, bed rest
- ceftriaxone IM X 1 dose + azithromycin (or doxy)
may add metronidazole to cover for anaerobes
tx of those w. severe dz
Women with severe disease should be hospitalized for IV antibiotic therapy and possible surgery.
Cefotetan or Cefoxitin PLUS doxycycline
Doxycycline should be continued orally for 14 day
when to hospitalize a pt w/ PID
- surgical emergencies
- prego
- doesn’t respond to oral antimicrobial tx
- unable to follow to tolerate oral regimen
- severe illnes
- TO abscess
