Pelvic Inflammatory Disease (PID)
Definition
Risk factors
o Young age at first sex; new/multiple/symptomatic sexual partners;
o Non-barrier contraception; oral contraception;
o IUD
o Sex during menses
o Bacterial vaginosis
o Vaginal douching
Clinical features
Symptoms
Range from asymptomatic to severe
Fever
Lower abdominal or pelvic pain
Cervical or vaginal discharge (new or regular)
Dyspareunia
Irregular menstrual period
Sexually active (or even if deny sexually active)
NOTE: #1 cause of discharge: BV. #2 cause: Candida inf (Thrush)
Signs
Fever
Lower abdominal or pelvic tenderness
VE: Cervical motion tenderness; uterine or adnexal tenderness
Sexual History
P ractices
P rotection
P artners
P revious STI
P regnancy
Investigations
o Vaginal swab – HVS/LVS
Management
Prognosis
Risk factor for infertility
Source
Uptodate 2014 (Clinical features and diagnosis of PID)
- PID represents a spectrum of clinical disease, from endometritis to fatal intraabdominal sepsis.
- Refers to acute infection of the upper female genital tract structures, including the uterus, oviducts, and/or ovaries. Neisseria gonorrhoeae and Chlamydia trachomatis are often implicated, although vaginal flora may also play an important role in pathogenesis.
- Adverse consequences of untreated PID, should have low threshold for diagnosis of PID and consider presumptive treatment in suspect cases, particularly in sexually active young women with lower abdominal pain with pelvic tenderness (cervical motion tenderness, uterine tenderness, or adnexal tenderness)
Risk factors
- Sexually active young women
- STD; partner has STD
- Risk factors for STD
o Young age at first sex; new/multiple/symptomatic sexual partners;
o Non-barrier contraception; oral contraception;
- Factors that potentially faciliate PID:
o IUD
o Sex during menses
o Bacterial vaginosis
o Vaginal douching
Clinical features
Symptoms
Range from asymptomatic to severe
Fever
Lower abdominal or pelvic pain
Cervical or vaginal discharge (new or regular)
Dyspareunia
Irregular menstrual period
Sexually active (or even if deny sexually active)
NOTE: #1 cause of discharge: BV. #2 cause: Candida inf (Thrush)
Signs
Fever
Lower abdominal or pelvic tenderness
VE: Cervical motion tenderness; uterine or adnexal tenderness
Sexual History
P ractices
P rotection
P artners
P revious STI
P regnancy
Investigations
- FBC, ESR/CRP (signs of inflammation)
- Β-HCG – rule out ectopic
- Cervical or vaginal discharge – Swab + M/C/S
o Vaginal swab – HVS/LVS
- Urinalysis
- ± Pelvic ultrasound esp if acutely ill + PID – rule out pelvic abscess
- ± Laparoscope
- If diagnosed with PID, should be tested for HIV
- ± HIV testing, HepB testing, syphillis
- Histologic evidence of endometritis on biopsy
- Imaging showing features of PID
- Laparoscopic abnormalities consistent with PID
Management
- Antibiotics – oral or IV depending on severity
- Outpatient or admit to hospital depending on severity
- Male partners of women with PID should be examined and treated if had sexual contact with patient during previous
Prognosis
Risk factor for infertility
Source
Uptodate 2014 (Clinical features and diagnosis of PID)