A brief on Pelvic Inflammatory Disease for undergraduate medical students

1. PELVIC INFLAMMATORY DISEASE

2. Definition
 Infection and inflammatory disorder of upper female
genital tract including uterus, fallopian tubes &adjacent
pelvic structures.
 Ascending infection

4. Organisms involved
 N gonorrhoea
 C Trachomatis
 T vaginalis
 M tuberculosis

5.  Risk Factors
 Douching
 Multilple sexual partners
 Low SE status
 Previous h/o PID
 Other STDs
 Procedures: S&E,
Endometrial bioplsy,
curettage
Protective Factors
OCPs
Tubectomy

6. PID
Silent Acute Chronic

7.  Silent PID
 Diagnosis of exclusion
 Sequelae of multiple or continuous low-grade infection
 Tubal factor infertility with incompatible history of upper genital
tract infection
 On laparoscopy:
 Normal looking Fallopian tubes with evidence of flattened mucosal
folds
 Hydrosalpinx
 Flimsy adhesions between liver capsule and anterior abdominal wall

9. Acute PID
 Minimum criteria
 Uterine tenderness
 Adnexal tenderness
 Cervical motion tenderness
 Additional criteria (any one)
 Oral temp >101.6 F
 Mucopurulent cervical discharge
 WBCs on cervical smear
 Raised CRP/ESR
 Presence of cervical N gonorrhoeae or C trachomatis

10. Diagnosis
 Symptoms:
 Pain abdomen, fever,
anorexia
 Heavy menstrual
bleeding, dysmenorrhoea,
nausea/vomiting
 Dyspareunia
 Signs:
 Cervical motion
tenderness
 Rebound tenderness in

11.  Investigations:
 CBC
 Liver function tests
 Cervical smear
 Tests for Neiserria and Chlamydia
 Screening for other STDs.
 USG

12. Treatment
 Antibiotics:
 IV cefoxitin, cefotetan or ceftriaxone
 Alternatively: IV clindamycin + Gentamicin or Ampicillin + oral
doxycycline
 Oral Doxycycline + Metronidazole
 Surgery:
 If tubo-ovarian mass/abscess with rupture or large mass (>8 cm)
 No response to therapy
 USG guided drainage of abscess may be considered.

13. Complications
 Tubo-ovarian abscess
 Fitz-Hugh-Curtis Syndrome
 Chronic PID
 Ectopic pregnancy
 Tubal factor infertility