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Questions and Answers
What is a common cause of pelvic inflammatory disease (PID)?
Which of the following is NOT considered a risk factor for pelvic inflammatory disease?
What symptom may indicate the presence of pelvic inflammatory disease?
Which condition is referred to as inflammation of the ovaries?
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Which type of swab is recommended for testing for gonorrhea and chlamydia in PID diagnosis?
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What is the term for inflammation of the fallopian tubes?
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Which symptom is commonly associated with pelvic inflammatory disease during sexual activity?
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Which organism is less commonly associated with pelvic inflammatory disease?
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What is most helpful in excluding pelvic inflammatory disease (PID)?
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Which of the following is NOT a suggested outpatient antibiotic regimen for PID management?
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What complication is specifically associated with pelvic inflammatory disease?
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Which of the following can be used to visualize and treat adhesions in Fitz-Hugh-Curtis syndrome?
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In what situation is admission to the hospital required for PID?
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What role do inflammatory markers like CRP and ESR play in PID diagnosis?
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Which organism is specifically targeted by the intramuscular ceftriaxone in treatment regimens for PID?
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What symptom is associated with Fitz-Hugh-Curtis syndrome due to liver capsule inflammation?
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Study Notes
Pelvic Inflammatory Disease (PID)
- Inflammation and infection of pelvic organs, caused by infection spreading from the cervix.
- Significant cause of tubal infertility and chronic pelvic pain.
- Affects the endometrium, fallopian tubes, ovaries, parametrium (connective tissue around the uterus), and peritoneum.
Causes
- Most cases are caused by sexually transmitted infections (STIs):
- Neisseria gonorrhoeae: Tends to cause more severe PID.
- Chlamydia trachomatis.
- Mycoplasma genitalium.
- Can be caused by non-sexually transmitted infections:
- Gardnerella vaginalis (bacterial vaginosis).
- Haemophilus influenzae (respiratory infections).
- Escherichia coli (urinary tract infections).
Risk Factors
- Similar to other STIs:
- Not using barrier contraception.
- Multiple sexual partners.
- Younger age.
- Existing STIs.
- Previous PID.
- Intrauterine device (IUD).
Presentation
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Symptoms:*
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Pelvic or lower abdominal pain.
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Abnormal vaginal discharge.
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Abnormal bleeding (intermenstrual or postcoital).
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Pain during sex (dyspareunia).
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Fever.
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Dysuria.
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Examination Findings:*
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Pelvic tenderness.
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Cervical motion tenderness (cervical excitation).
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Inflamed cervix (cervicitis).
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Purulent discharge.
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Other Potential Findings:*
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Fever and signs of sepsis.
Investigations
- Testing for causative organisms and other STIs:
- NAAT swabs for gonorrhea and chlamydia.
- NAAT swabs for Mycoplasma genitalium (if available).
- HIV test.
- Syphilis test.
- High vaginal swab for bacterial vaginosis, candidiasis, and trichomoniasis.
- Microscopic examination of vaginal or endocervical swabs for pus cells (absence suggests PID is unlikely).
- Pregnancy test for sexually active women with lower abdominal pain (to rule out ectopic pregnancy).
- Elevated inflammatory markers (CRP and ESR) can support the diagnosis.
Management
- Referral to a genitourinary medicine (GUM) specialist for management and contact tracing.
- Empirical antibiotic treatment (before swab results) to avoid delays and complications based on local/national guidelines.
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Example Outpatient Regime:
- Single dose of intramuscular ceftriaxone 1g (for gonorrhea).
- Doxycycline 100mg twice daily for 14 days (for chlamydia and Mycoplasma genitalium).
- Metronidazole 400mg twice daily for 14 days (for anaerobes like Gardnerella vaginalis).
Complications
- Sepsis.
- Abscess.
- Infertility.
- Chronic pelvic pain.
- Ectopic pregnancy.
- Fitz-Hugh-Curtis syndrome.
Fitz-Hugh-Curtis Syndrome
- Complication of PID caused by inflammation and infection of the liver capsule (Glisson's capsule).
- Leads to adhesions between the liver and peritoneum.
- Bacteria can spread from the pelvis via the peritoneal cavity, lymphatic system, or blood.
- Results in right upper quadrant pain that can refer to the right shoulder tip (due to diaphragmatic irritation).
- Laparoscopy can be used for visualization and treatment (adhesiolysis).
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Description
This quiz covers Pelvic Inflammatory Disease (PID), focusing on its causes, symptoms, and risk factors. Understand the significant role of sexually transmitted infections in PID and the implications on women's health, including infertility and chronic pain.
