Basildon EM Handbook 2018

Pelvic inflammatory disease (PID)

March 2018 | by EMauthor

Pelvic inflammatory disease (PID) is usually the result of infection ascending from the endocervix causing endometritis, salpingitis, oophoritis, tubo-ovarian abscess, and/or peritonitis.

Causes of PID

•Sexually transmitted (90%) Chlamydia, Gonorrhoea, Mycoplasma genitalium.

•Non-sexually transmitted (10%, often post-surgical instrumentation) —E . Coli, Group B Strep, Bacteriodes, Gardenella .

Clinical features of PID

•Lower abdominal pain and tenderness.

•Abnormal vaginal or cervical discharge.

•Fever

•Deep dyspareunia.

•Cervical excitation.

•Adnexal tenderness ± mass.

Investigations in PID

•Endocervical swabs for Chlamydia and Gonorrhoea.

•Urinary pregnancy test

•Bloods — CRP, and WCC are supportive but not specific.

•Transvaginal ultrasound may demonstrate inflamed/dilated Fallopian tubes or an abscess.

Management of PID

•Mild to moderate PID can be treated as an outpatient with oral ofloxacin 400 mg bd and metronidazole 400 mg bd for 14 days.

•Inpatient management is indicated in the following circumstances:

oclinically severe disease

otubo-ovarian abscess

oPID in pregnancy

ointolerance or lack of response to oral therapy

osurgical emergency not excluded.

•Inpatient antibiotic therapy is intravenous ceftriaxone and doxycycline.

•Surgical drainage may be required for tubo-ovarian abscesses.

•Sexual partners from the previous 6 months should be contacted and offered screening via the genitourinary medicine clinic.

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