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

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

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

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