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Pelvic inflammatory disease
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum. It is usually the result of ascending infection from the endocervix.Causative organisms
- Chlamydia trachomatis: the most common cause
- Neisseria gonorrhoeae
- Mycoplasma genitalium
- Mycoplasma hominis
Features
- lower abdominal pain
- fever
- deep dyspareunia
- dysuria and menstrual irregularities may occur
- vaginal or cervical discharge
- cervical excitation
Investigation
- a pregnancy test should be done to exclude an ectopic pregnancy
- high vaginal swab
- these are often negative
- screen for Chlamydia and Gonorrhoea
Management
- due to the difficulty in making an accurate diagnosis, and the potential complications of untreated PID, consensus guidelines recommend having a low threshold for treatment
- first-line: stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole - this now considered first-line due to the desire to avoid systemic fluoroquinolones where possible
- alternative regime: oral ofloxacin + oral metronidazole
- RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ' Removal of the IUD should be considered and may be associated with better short term clinical outcomes'
Complications
- perihepatitis (Fitz-Hugh Curtis Syndrome)
- occurs in around 10% of cases
- it is characterised by right upper quadrant pain and may be confused with cholecystitis
- infertility - the risk may be as high as 10-20% after a single episode
- chronic pelvic pain
- ectopic pregnancy
+PassMedicine Notes
Pelvic inflammatory disease (PID) is a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum. It is usually the result of ascending infection from the endocervix.
Causative organisms- Chlamydia trachomatis: the most common cause
- Neisseria gonorrhoeae
- Mycoplasma genitalium
- Mycoplasma hominis
- lower abdominal pain
- fever
- deep dyspareunia
- dysuria and menstrual irregularities may occur
- vaginal or cervical discharge
- cervical excitation
- a pregnancy test should be done to exclude an ectopic pregnancy
- high vaginal swab
- these are often negative
- screen for Chlamydia and Gonorrhoea
- due to the difficulty in making an accurate diagnosis, and the potential complications of untreated PID, consensus guidelines recommend having a low threshold for treatment
- first-line: stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole - this now considered first-line due to the desire to avoid systemic fluoroquinolones where possible
- alternative regime: oral ofloxacin + oral metronidazole
- RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in. The more recent BASHH guidelines suggest that the evidence is limited but that ' Removal of the IUD should be considered and may be associated with better short term clinical outcomes'
- perihepatitis (Fitz-Hugh Curtis Syndrome)
- occurs in around 10% of cases
- it is characterised by right upper quadrant pain and may be confused with cholecystitis
- infertility - the risk may be as high as 10-20% after a single episode
- chronic pelvic pain
- ectopic pregnancy
