Pelvic Inflammatory Disease

PID: Definition & Etiology - PID's Pesky Pathogens

• Definition: A spectrum of inflammatory disorders of the upper female genital tract, including endometritis, salpingitis, oophoritis, tubo-ovarian abscess, and pelvic peritonitis.
• Common Causative Organisms:
  • N. gonorrhoeae, C. trachomatis (📌 Go Chlamydia!)
  • Polymicrobial: Anaerobes, Mycoplasma genitalium
• Key Risk Factors:
  • Multiple sexual partners, young age (<25 yrs)
  • Previous PID, recent IUCD insertion
  • Douching, history of STIs

⭐ Polymicrobial infection is common in PID, often involving N. gonorrhoeae, C. trachomatis, and anaerobes.

PID: Clinical Features - PID's Painful Profile

• Common Symptoms:
  • Lower abdominal/pelvic pain (often bilateral)
  • Abnormal vaginal discharge (e.g., mucopurulent)
  • Intermenstrual or postcoital bleeding
  • Dyspareunia
  • Fever
• Key Signs:
  • Cervical motion tenderness (CMT) - "Chandelier sign"
  • Adnexal tenderness (usually bilateral)
  • Uterine tenderness
  • Fever >38.3°C
• Clinical Spectrum: Can range from asymptomatic/subclinical to severe, acute PID.

⭐ Cervical motion tenderness (CMT), also known as the 'Chandelier sign', is a classic sign of PID but not universally present.

PID: Diagnosis - PID's Clue Hunt

• CDC Minimum Criteria (≥1 for Dx):
  • Cervical Motion Tenderness (CMT)
  • Uterine tenderness
  • Adnexal tenderness
  • (Sexually active young women, pelvic pain, no other cause)
• Additional Criteria (↑ specificity):
  • Fever >38.3°C; Abnormal discharge
  • ↑ WBCs (wet mount); ↑ ESR/CRP
  • Positive GC/CT NAAT
• Definitive: Endometrial biopsy; TVS/MRI (thick tubes); Laparoscopy.
• Investigations: hCG test, GC/CT NAATs, Wet mount, ESR/CRP, USG (for TOA).

⭐ Initiate empirical PID treatment in sexually active young women with pelvic/lower abdominal pain if no other cause is found AND ≥1 minimum clinical criteria (CMT, uterine/adnexal tenderness) present on pelvic exam.

PID: Management - PID's Treatment Triumph

Goals: Eradicate infection, relieve symptoms, prevent sequelae.

Hospitalize if: Surgical emergency, pregnancy, severe illness/TOA, oral intolerance, outpatient failure.

Treatment Regimens (CDC):

• Notify & treat all sexual partners (within past 60 days).
• Abstain from intercourse until therapy completed & symptoms resolved.

⭐ All sexual partners of a patient with PID from the preceding 60 days should be evaluated, tested, and presumptively treated for chlamydia and gonorrhea, regardless of test results.

PID: Complications - PID's Lingering Legacy

• Short-term:
  • Tubo-ovarian abscess (TOA)
  • Fitz-Hugh-Curtis syndrome (perihepatitis; RUQ pain, 'violin-string' adhesions)
  • Sepsis
• Long-term:
  • Infertility (tubal; risk ↑ with episodes)
  • Ectopic pregnancy (risk ↑ 6-10 fold)
  • Chronic pelvic pain, dyspareunia
  • Hydrosalpinx

⭐ Fitz-Hugh-Curtis syndrome, characterized by perihepatitis and 'violin-string' adhesions between the liver capsule and peritoneum, is a known complication of PID, typically caused by C. trachomatis or N. gonorrhoeae.

High‑Yield Points - ⚡ Biggest Takeaways

• PID is most commonly caused by Chlamydia trachomatis & N. gonorrhoeae.
• Key diagnostic signs: Cervical motion tenderness (CMT), uterine, or adnexal tenderness.
• Laparoscopy is gold standard for diagnosis, but clinical criteria are usually sufficient.
• Standard outpatient treatment: Ceftriaxone IM + Doxycycline oral ± Metronidazole oral.
• Fitz-Hugh-Curtis syndrome: Perihepatitis (violin-string adhesions) is a specific complication.
• Major sequelae include infertility, ectopic pregnancy, and chronic pelvic pain.
• Tubo-ovarian abscess (TOA) is a serious complication requiring prompt management_._