🔑 Key Learning

  • Infection ascends from cervix to upper genital tract (endometritis, salpingitis, oophoritis).
    • Causative organisms include chlamydia, gonorrhoea, and mycoplasma genitalium.
  • Long-term complications include infertility and ectopic pregnancy.
  • Empiric management is with ceftriaxone, doxycycline, and metronidazole.

🦠 Pathophysiology

  • Infection of the upper genital tract due to ascending infection from the endocervix.
  • Commonly leads to endometritis, salpingitis, and/or oophoritis.
  • Aetiology
    • Chlamydia trachomatis and Neisseria gonorrhoeae (∼25% of cases)
    • Mycoplasma genitalium, anaerobes, enteric gram-negatives
  • Risk Factors:
    • Age < 25 years
    • Recent termination of pregnancy
    • 4–6 weeks post-IUD insertion
    • Multiple sexual partners

👀 Clinical Features

  • Lower abdominal pain
  • Deep dyspareunia
  • Purulent vaginal discharge
  • Intermenstrual or postcoital bleeding
  • Fever
  • Examination findings:
    • Cervical motion tenderness
    • Adnexal tenderness on bimanual exam
    • Pyrexia, signs of systemic inflammation

🧪 Investigations

  • Clinical assessment.
  • Pregnancy test – to exclude ectopic pregnancy
  • Endocervical swabs – for CT, NG, MG
  • Bloods – CRP/WCC usually raised
  • Microscopy: absence of pus cells has high NPV
  • Imaging: consider pelvic USS if abscess suspected

💊 Management

Outpatient Regimens (BASHH)

  • IM ceftriaxone 1g stat + PO doxycycline 100mg BD + PO metronidazole 400mg BD for 14 days
  • Alternatives:
    • PO ofloxacin + metronidazole for 14 days
    • PO moxifloxacin for 14 days (esp. if M. genitalium)

Inpatient Regimens

  • IV ceftriaxone + IV doxycycline (followed by PO doxycycline + metronidazole)
  • OR IV clindamycin + IV gentamicin (followed by PO clindamycin + metronidazole)

📝 Exam Clues & Clinchers

  • Young woman with pelvic pain, dyspareunia, and cervical motion tenderness
  • First-line test: pregnancy test + endocervical swabs (CT/NG/MG)
  • First-line treatment: IM ceftriaxone + PO doxycycline + PO metronidazole for 14 days 

   

🔗 Useful Links and References

BASHH. PID [2019]. Available at URL: https://www.bashhguidelines.org/current-guidelines/systemic-presentation-and-complications/pid-2019/