Pelvic inflammatory disease

Includes: endometritis, salpingitis, tubo-ovarian abscess, pelvic cellulitis and pelvic peritonitis
Mainly occurs in young nulliparous women (<25yo)
Risk factors
- young age
- high frequency of partner change
- lack of barrier contraception
- low socioeconomic group, and
- smoking

Symptoms:
- Abdo pain, +/- fever
- dyspareunia
- menstrual problems
- intermenstrual bleeding
- purulent vaginal discharge
- painful or frequent urination
Can be acute or chronic.
- Acute 🡪 sudden severe symptoms. Fever >38 deg, moderate to severe lower abdominal pain +/- rigidity
- Chronic 🡪 gradually produces milder symptoms or follow an acute episode. Ache in the lower back with mild lower abdominal pain
Signs
- Lower abdominal tenderness/
- guarding/rebound
- Adnexal tenderness or a mass
- Cervical motion tenderness
Causes
- Exogenous 🡪 caused by sexual activity. Chlamydia trachomatis is the most commonly identified sexually transmitted pathogen, followed by Neisseria gonorrhoeae and Mycoplasma genitalium
- Endogenous 🡪 lower genital tract bugs, eg. E.Coli and Bacteroides fragilis. Think IUD, recent pregnancy, D+C, abortion or gynaecological procedure, recent genital tract manipulation.
- Actinomycosis 🡪 Due to prolonged IUD use
Investigations: Cervical swabs, blood culture, pelvic ultrasound
Mx:
- Remove IUD or retained products
- Treat sexual partners
- If sexually acquired:
  - ceftriaxone 500 mg in 2 mL of 1% lidocaine IM PLUS
  - Metronidazole 400 mg orally, 12-hourly for 14 days PLUS EITHER
    - doxycycline 100 mg orally, 12-hourly for 14 days OR

(patients who are pregnant, breastfeeding or likely to be nonadherent to doxycycline)

If non-sexually acquired:
- Augmentin DF plus doxycycline.
PID caused by MM. genitalium infection
- Moxifloxacin 400 mg orally, daily for 14 days
Complications: tubal obstruction, infertility, ectopic pregnancy