O+G
PID
STI = ⅓ to ½ of PID. ie: its mostly not STI caused. - RACGP
PromptDifferential of gynaecologic causes of pain
ResponseOvarian torsion
Ruptured ovarian cyst
Haemorrhagic cyst
Mittelschmerz (mid cycle pain D7-24)
Fibroid complication (Red degeneration, bleeding, torsion)
Endometriosis
Adenomyosis
Pregnancy
Ruptured ovarian cyst
Haemorrhagic cyst
Mittelschmerz (mid cycle pain D7-24)
Fibroid complication (Red degeneration, bleeding, torsion)
Endometriosis
Adenomyosis
Pregnancy
PromptHistorical features of PID (or risk factors)
ResponseVaginal discharge
Prior PID
Multiple sexual partners
Unprotected sex
Presence of recently inserted IUD
Recent instrumentation
Dyspareunia
Prior PID
Prior PID
Multiple sexual partners
Unprotected sex
Presence of recently inserted IUD
Recent instrumentation
Dyspareunia
Prior PID
PromptImportant questions in PID
ResponseMenstrual history - ? Pregnant
?SA - Criminal implications + ? needs PEP
?IUD - may need removal if infected
?SA - Criminal implications + ? needs PEP
?IUD - may need removal if infected
PromptExamination findings in PID
ResponseFevers
Lower abdo tenderness/guarding
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Cervical appearance on spec
Mucopuralant discharge (L pic), prominent ectropion (R pic), friable/easily bleeding (R pic)
- ECI “PID” Aug ‘24
Lower abdo tenderness/guarding
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness
Cervical appearance on spec
Mucopuralant discharge (L pic), prominent ectropion (R pic), friable/easily bleeding (R pic)
- ECI “PID” Aug ‘24PromptInvestigations for PID
ResponseUrine (first pass) PCR - sensitive for chlamydia/ghonorrhoea
High vaginal (endocrervical) swabs - STI culture
bHCG - ? pregnant, (DDx and may alter antibiotic prescription)
Pelvic US - exclude tubo-ovarian abscess (NOT CT)
Extended serology Syphilis, HIV, hepatitis
LFT’s - ? fitz-hugh-curtis syndrome
(inflammatory markers to guide response but needs to be WELL justified… better answers)
High vaginal (endocrervical) swabs - STI culture
bHCG - ? pregnant, (DDx and may alter antibiotic prescription)
Pelvic US - exclude tubo-ovarian abscess (NOT CT)
Extended serology Syphilis, HIV, hepatitis
LFT’s - ? fitz-hugh-curtis syndrome
(inflammatory markers to guide response but needs to be WELL justified… better answers)
PromptUS findings in PID
ResponseNormal ultrasound
Fluid in pouch of douglas
Thickening (>5mm) or increased vascularity of fallopian tubes
Tubo-ovarian abscess/complex adnexal mass
Fluid in pouch of douglas
Thickening (>5mm) or increased vascularity of fallopian tubes
Tubo-ovarian abscess/complex adnexal mass
PromptCT findings in PID
ResponseObscuration of pelvic fascial planes
Cervicitits
Oopheritis - fat stranding
Salpingitis - fat stranding
Thickening of uterosacral ligaments
Simple or complex fluid/abscess collection
Cervicitits
Oopheritis - fat stranding
Salpingitis - fat stranding
Thickening of uterosacral ligaments
Simple or complex fluid/abscess collection
PromptPID over Appendicitis
ResponseFavours PID
Absence of migration
Bilateral abdo tenderness
Absence of N/V
Purulent PV discharge
Absence of migration
Bilateral abdo tenderness
Absence of N/V
Purulent PV discharge
PromptManagement PID
ResponseABx from ETG may ‘24
Sexual cause
Nonsevere STI (or asymptomatic + pregnant)
Sexual health follow up
Counselling re: Safe sex practices
Contact tracing information
Procedural cause
Nonsevere post procedural
Sexual cause
Nonsevere STI (or asymptomatic + pregnant)
- Ceftriaxone 500 mg IV/IM
- PLUS Metronidazole 500 mg BD x 14 days
- PLUS Doxycycline 100 mg BD x 14 days
- Replace doxy with azithro 1g stat + repeat at 1wk if non compliant or pregnant
- (Note chlamydia = doxy/azithro, gonorrhoea = cef/azithro)
- Ceftriaxone 2g daily
- PLUS azithro 500 mg daily
- PLUS metronidazole 500 mg BD
- Admit
Sexual health follow up
Counselling re: Safe sex practices
Contact tracing information
Procedural cause
Nonsevere post procedural
- Augmentin BD x 14 days
- Surgical tripples - gent/metro/amp
PromptComplications of PID
ResponseTuboovarian abscess
Scarring with fertility complications (or risk of ectopic)
Transmission to sexual partners
Chronic pelvic pain
Scarring with fertility complications (or risk of ectopic)
Transmission to sexual partners
Chronic pelvic pain