Term
PID- Pelvic Inflammatory Disease
A spectrum of inflammatory disorders of the upper genital tract
Risk Factors Include: |
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Definition
Adolescents
HO PID, GC, CT
Partner with GC, CT
Multiple Partners
Douching
IUD insert when infected with GC,CT
BV
No condom/barrier use
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Term
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Definition
1. disruption of normal flora
2. epithealial damage
3. disruption of cervical mucus barrier |
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Term
Etiology
Caused by bacterial ascending from vagina to endocervical canal, to upper genital tract
Most Common Pathogens Include:
1.
2.
3.
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Definition
1. GC
2. CT
3. GC and CT-often polymicrobial
Not as common but possible causes: E.coli, strep, ect. |
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Term
Subjective Data
Pt may complain of these symptoms: |
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Definition
Lower abdominal pain
Heavy vaginal discharge with odor
Irregular bleeding
Dyspurunia
Low Back Pain
Fever, Fatigue, N/V, diarrhea
Painful or difficult urination
or ASYMPTOMATIC |
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Term
| Most common clinical presentation of PID is: |
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Definition
No pain-asymptomatic
Only 40% of pts will present with moderate or sever symptoms
Up to 60% will be asymptomatic |
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Term
Minimum Objective Data needed to treat empirically:
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Definition
uterine tenderness and/or
adnexal tenderness and/or
cervical motion tenderness
if these are present go ahead and treat for PID even before cultures come back |
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Term
| Objective Data to aid in DX |
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Definition
Mucopurulent cervical discharge
CMT
Adnexal tenderness
uterine tenderness
Lots of white cells on wet mount
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Term
PID Management
When to start tx?
Do you do a pelvic?
Pain meds?
Antibiotics used? |
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Definition
TX as soon as possible
Do a pelvic if possible, however pt may not tolerate r/t pain
Analgesics can be used
Broad Spectrum |
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Term
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Definition
Ceftriaxone 250 mg IM in a single dose OR Cefoxitin 2 g IM in a single dose and Probenecid, 1 g orally administered concurrently in a single dose
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days |
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Term
Hospitalize when:
1.
2.
3.
4.
5.
6.
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Definition
1. Pregnant
2. No response to TX after 72hrs
3.When you can not rule out surgical emergency
4. Pt unable to tolerate PO medication
5. Severe illness
6. Immunocompromised: HIV with low CD4 count
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Term
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Definition
Take all meds as instructed
Partner needs tested and treated
Call if non-response to TX in 72 hrs
Offer HIV testing
Discuss risks of reinfections and potential health implication of PID and repeated infection |
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Term
Follow Up
When to call back?
Test of cure?
Routine Testing? |
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Definition
Call back if no response to TX within 72 hrs
Test of cure 4-6wks after finishing TX
Annual chlamydia testing for sexually active under 25yo and over 25yo when multiple sex partners; and women in 1st trimester
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