Editing Pelvic inflammatory disease


Acute infection of upper genital tract structures

* Endometritis, salpingitis, oophoritis, peritonitis, perihepatitis, TOA
* 85% caused by STI
** Chlamydia most common
** Gonorrhoea less common
** Mycoplasma genitalium

== Risk factors ==

* Young age at first sexual activity
* High number of sexual partners
* Current use of IUCD
* Surgical procedures

== Clinical features ==

* Any sexually active female, esp those with multiple sexual partners and not using barrier protection
* Acute symptomatic
** Lower abdo pain, usually bilateral, generally 1-14 days, worsens with coitus/jarring movements, esp if starts during/after menses
** Dyspareunia
** If severe - fevers, sepsis
** Abnormal uterine bleeding in 30%
** Lower abdo signs
** Cervical motion/uterine/adnexal tenderness on pelvic exam are defining characteristics
** Purulent endocervical discharge/vaginal discharge
** Only a minority have elevation in inflammatory markers
* Perihepatitis (Fitz-Hugh Curtis Syndrome)
** Traditionally gonococcal, but now can be chlamydia
** Pathophysiology:
*** Mucopurulent exudates via Fallopian tubes
*** Scarring, adhesions, TOA
*** Infected fluid tracks up the right paracolic gutter to peri-hepatic area, where it can cause pain and adhesion formation (liver capsular stretch)
* Tubo-ovarian abscess
** Originates from local spread (bowel, adnexal surgery), haematological spread or ascending gynaecological infection
** Endothelial damage leads to tubal blockage and abscess formation

== Differential diagnosis ==

* Endometriosis
* UTI
* Appendicitis
* GIT dysfunction
* Ectopic
* Ovarian cyst accident

== Investigation ==

* USS pelvis - hydrosalpinges and/or TOA
* Cervical swabs
** Can ask for a gram stain - gram-negative intracellular diplococci would be gonorrhoea
** Absence of positive result does not exclude PID

== Treatment ==

* Broad-spectrum Abx for 72 hours then laparoscopy if no improvement
* If high suspicion of alternative diagnosis, just go straight to surgery
* Contact tracing
* IUD should be removed

== Complications ==

* Chronic pelvic pain
* Increased risk of ectopic
* Fitz-Hugh-Curtis
* Infertility - approximately 20% of women treated for PID will become infertile secondary to tubal damage

[[Category:O+G]]