PID

 

Infection of uterus, fallopian tubes and adjacent pelvic structures. Long term sequel
( infertility ) occurs in 25%.

Etiology:

  1. ascending infection is commonly 2ry to Chlamydia trachomatis and Neisseria gonorrheae.
     
  2. other organism identified  are E. coli, bacteroides species, Mycoplasma hominis and Ureaplasma urealyticum.
     
  3. Risk factors: young age, multiple partners. While barrier and  oral contraceptives protect from  PID,  the  intrauterine devices are predisposing factor, especially  for non-gonococcal and non-chlamydial  infections.
     

S&S:

  1. lower abdominal pain, usually bilateral.
     
  2. abnormal vaginal discharge.
     
  3. uterine bleed, dysuria, dyspareunia.
     
  4. N/V, Fever are present when PID becomes systemic.
     
  5. more likely during 1st  half of menstrual period.
     
  6. infections  that are asymptomatic or have atypical presentation also occur. As a matter  of  fact 30 - 80 %  of women  with classical  sequel of PID, the infertility, do not remember the disease.

DX:

  1. laparoscope is the gold standard
     
  2. clinical: lower abdominal pain, adnexal tenderness, pain with manipulation of cervix. These are present in 90% of cases. WBC, fever, ESR,  C-reactive protein  can also  occur.
     
  3. endovaginal US. This is done mainly to r/o other pathologies (Appy, TOA)
     
  4. culdocenthesis (historical oddity)

Treatment:

  1. CRITERIA for  HOSPITALIZATION:
    • possibility of surgical emergency
    • pelvic abscess is suspected
    • pregnant patient
    • unable to F/U in 72 hrs.
    • no improvement  on OPD regiment
    • severe  illness (e.g. HIV ) that precludes OPD management
       

   2. ANTIBIOTICS for   INPATIENT  USE:

 Recommended

    Cefoxitin 2gm IV q6 hr

            PLUS

    Doxycycline 100mg IV or PO q12h ( if pregnant patient  Erythro 500mg q6 x7d is given )

  Alternaitve

Clindamycin 600-900mg IV q8 hr.

            PLUS

Gentamicin 100mg 1st dose OR  2mg/kg IV load followed by 1.5mg/kg q8h

 

3.  ANTIBIOTICS FOR OPD  USE :

 Commonly prescribed are:

Ceftriaxone 125-250mg IM x 1 dose OR Cipro 500 mg x 1dose   

              PLUS                                          

Doxycycline 100mg  BID x 14 days (do not give it in pregnancy) OR

Azithromycin  1 gm PO x 1dose

Complications:

    1. infertility

    2. Fitz - Hugh - Curtis syndrome: occurs 2ry to discharge of pus from tubes
       that  localizes  around the liver   and can simulate acute  cholecystitis

    3. Reiter's  syndrome

    4. TOA

NOTE: EVALUATION  OF  SEXUAL  PARTNER    IS  INTEGRAL  PART OF  TREATMENT

 

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