Makindo Medical Notes

⚠️ Key exam pearl: Lower abdominal pain and adnexal tenderness are the most consistent findings of PID. Always consider in sexually active women with pelvic pain, discharge, or fever.

📖 About

• Pelvic Inflammatory Disease (PID) is an infectious and inflammatory disorder of the upper female genital tract — uterus, fallopian tubes, ovaries ± peritoneum.
• Most often caused by ascending STIs from the cervix/vagina.
• Untreated PID can result in infertility, ectopic pregnancy, chronic pelvic pain.

🦠 Aetiology

PID is usually polymicrobial, often triggered by STIs and complicated by anaerobes.

• STIs: Chlamydia trachomatis, Neisseria gonorrhoeae.
• Other bacteria: anaerobes, Gardnerella, streptococci, staphylococci, E. coli.
• Risk factors: multiple partners, prior STI, IUCD insertion (esp. first 3 weeks).

🤒 Clinical Presentation

• Systemic: fever >38°C, malaise, nausea/vomiting.
• Pelvic: bilateral lower abdominal pain, deep dyspareunia, abnormal bleeding, offensive vaginal discharge.
• Exam findings: cervical motion tenderness (CMT), adnexal tenderness ± masses, uterine tenderness.

🧾 Differential Diagnosis

• Appendicitis
• Ectopic pregnancy
• Ovarian torsion/cyst rupture
• UTI or pyelonephritis
• IBD flare (Crohn’s/UC)

⚡ Complications

• Infertility (tubal scarring, 15–20%)
• Ectopic pregnancy (5–10× risk)
• Chronic pelvic pain
• Tubo-ovarian abscess → sepsis, rupture
• Fitz-Hugh–Curtis syndrome (perihepatitis)

🔬 Investigations

• Bedside: pregnancy test (exclude ectopic), speculum exam, swabs for NAAT (chlamydia/gonorrhoea).
• Bloods: FBC, CRP/ESR, LFTs, U&E.
• Imaging: pelvic US (abscess, hydrosalpinx), MRI if unclear.
• Laparoscopy: gold standard — direct visualisation, cultures.

💊 Management

• Empirical antibiotics (start immediately, don’t wait for swabs):
  • IM Ceftriaxone 1 g stat + Doxycycline 100 mg PO BD 14 days ± Metronidazole 400 mg PO BD 14 days (covers anaerobes).
• Admission indications: severe illness, pregnancy, abscess, failed outpatient Rx, diagnostic uncertainty.
• Pain relief: NSAIDs, rest, fluids.
• Partner notification & treatment → essential to prevent reinfection.
• Surgery: drainage of tubo-ovarian abscess if no improvement in 72 hrs.

📉 Prognosis

• ✅ Early treatment: complete resolution in most women.
• ⚠️ Delayed treatment: tubal damage, infertility, ectopic pregnancy, chronic pelvic pain.
• 🔄 Recurrence risk: ~25% within 1 year if reinfected.

✅ Conclusion

PID is a preventable cause of infertility and ectopic pregnancy. Maintain a high index of suspicion in sexually active women with pelvic pain. Prompt antibiotics, partner treatment, and follow-up are key to reducing long-term harm.

📚 References

• CDC – Pelvic Inflammatory Disease
• NICE NG43: STIs & PID
• Wilson TJ, et al. BMJ 2018;361:k2135.