Pelvic Inflammatory Disease

General term for infection of the upper female genital tract, including the uterus, Fallopian tubes, and ovaries

Aetiology

  • Usually results from ascending infection from endocervix
    • Endometritis, salphingitis, tubo-ovarian abscess
    • Chlymydia, gonorrhoea, gardenella, anaerobes

Clinical presentation

Symptoms

  • Lower abdominal pain
  • Deep dyspareunia
  • Dysuria
  • Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia)
  • Abnormal vaginal discharge (especially if purulent or with an unpleasant odour)

Signs

  • On vaginal examination, there may be tenderness of uterus/adnexae or cervical excitation (on bimanual palpation)
  • There may be a palpable mass in the lower abdomen, with an abnormal vaginal discharge noted
  • In severe cases - fever above 38°C (but may be apyrexial)

Investigations

  • Full STI screen
  • Urine dipstick +/- MSU to exclude UTI
  • Pregnancy test
  • Transvaginal US - if severe disease or dignostic uncertainty
  • Laparoscopy - indicated only in severe cases where there is diagnostic uncertainty

Management

  • Metronidazole 400mg bd + ofloxacin 400mg bd (14 days)
  • If under 18 or high risk of gonorrhea - ceftriaxone 1G IM, doxycycline 100mg bd x 2 weeks and metronidazole 400mg bd x 2 weeks

Complications

  • Untreated PID can lead to serious complications, including infertility, ectopic pregnancy, abscess formation and chronic pelvic pain