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Pelvic inflammatory disease(PID) - Coggle Diagram
Pelvic inflammatory disease(PID)
Definition
Infection and inflammation of the upper female genital tract (endometrium, fallopian tubes, ovaries, pelvic peritoneum).
Management
Outpatient: Broad-spectrum antibiotics (e.g., ceftriaxone + doxycycline ± metronidazole)
Inpatient:IV antibiotics (e.g., clindamycin + gentamicin OR cefotetan + doxycycline)
Supportive: Analgesia, fluids, rest
Partner treatment (STI coverage)
Caused by
Sexually transmitted infections (STIs)
Neisseria gonorrhoeae
Chlamydia trachomatis
Polymicrobial infection
Anaerobes (Bacteroides, Peptostreptococcus)
Facultative bacteria (E. coli, Streptococcus agalactiae)
Mycoplasma, Ureaplasma
Risk factors
Multiple sexual partners
Unprotected intercourse
Previous STI / PID
Young age (<25 years)
IUCD insertion (short-term risk)
Pathophysiology
Ascending infection from cervix → endometritis → salpingitis → oophoritis → peritonitis
Inflammatory damage → scarring and adhesions
Tubal dysfunction → infertility, ectopic pregnancy
Investigations
Blood tests: CBC (↑WBC), ESR, CRP
Microbiology: Cervical swab (NAAT for N. gonorrhoeae, C. trachomatis), cultures
Imaging: Pelvic ultrasound (abscess, tubo-ovarian mass)
Definitive: Laparoscopy (direct visualization of inflamed tubes)
Clinical feature
Symptoms
Lower abdominal/pelvic pain
Abnormal vaginal discharge
Dyspareunia
Dysuria
Abnormal uterine bleeding (postcoital, intermenstrual, menorrhagia)
Fever, malaise
Signs
Lower abdominal tenderness
Cervical motion tenderness ("Chandelier sign")
Adnexal tenderness/mass
Fever, tachycardia
Complications
Tubo-ovarian abscess
Chronic pelvic pain
Infertility (tubal factor)
Ectopic pregnancy
Perihepatitis (Fitz-Hugh–Curtis syndrome)
Prevention
Safe sexual practices (condom use)
Regular STI screening
Prompt treatment of STIs
Education on reproductive health