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Dr.Niraj Mahajan
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PID

By AdminPosted On 05-Oct-2016

1. Treatment of PID

Is dual therapy (ceftriaxone with either azithromycin or doxycycline) for Gonococcal infection recommended, even with negative Chlamydia result?


a) Yes

b) No

Correct Answer: a) Yes. Dual therapy for gonococcal infections (i.e., with ceftriaxone in a single intramuscular dose, in combination with either azithromycin or doxycycline) is now recommended in the 2010 STD Treatment Guidelines, independent of the patient’s chlamydial infection status. N. gonorrhoeae has the potential to develop resistance to the few antimicrobial therapies available. Dual therapy may hinder the development of antimicrobial-resistant organisms. Finally, particularly in men, post-gonococcal urethritis can occur even in the absence of chlamydial infections. For all of these reasons, dual therapy is preferred for all patients with gonorrhea, irrespective of chlamydial test results.


2. Strawberry appearance of cervix is seen in

a) Trichomonas

b) Moniliasis

c) Gonococccus

d) Gardenella

e) Chlamydia

Correct Answer : a) Trichomoniasis.

Strawberry cervix, results from microscopic, punctate haemorrhages of the cervix. Only 2% of women with the Trichomonas infection will have a “strawberry” cervix (an erythematous cervix with pinpoint areas of exudation) or vagina on examination. This is due to capillary dilation as a result of the inflammatory response.


3. Test for PID

Which test is most sensitive in detecting pelvic inflammatory disease (PID) ?

a) Cell culture

b) Endocervical biopsy

c) Enzyme immunoassay

d) Microscopy

e) Nucleic acid amplification test


Correct Answer: e) Nucleic acid amplification test (NAAT). NAAT (polymerase chain reaction or strand displacement amplification) is more than 95% sensitive in detecting Chlamydia or Gonorrhoea from the endocervical specimen. The absence of endocervical or vaginal pus cells on a wet-mount smear has a good negative predictive value (95%) for a diagnosis of PID but their presence is non-specific (poor positive predictive value).


4. Pelvic inflammatory disease

What is the most appropriate treatment for pelvic inflammatory disease ?


a) Augmentin (co-amoxiclav)

b) Ceftriaxone 250 mg and azithromycin 1 g for 7 days

c) Doxycycline for 14 days

d) Metronidazole and doxycycline for 7 days

e) Ofloxacin


Correct Answer: b) Ceftriaxone 250 mg and azithromycin 1 g for 7 days.

Broad-spectrum antibiotic therapy is generally required to cover Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic infection. Ofloxacin should be avoided in women who are at high risk of gonococcal pelvic inflammatory disease (PID) because of increasing quinolone resistance.

Although the combination of oral doxycycline and metronidazole (without ceftriaxone) has been used to treat PID, there are no clinical trials adequately assessing its effectiveness and its use in isolation is not recommended. Ceftriaxone should be added as single dose. Data supporting azithromycin monotherapy for PID is also limited at present. However the addition of ceftriaxone pre-treatment is essential.


5. PID in Mentally Handicapped

Would the treatment be the same if a pelvic inflammatory disease (PID) was in a mentally handicapped person [i.e., due to poor genital hygiene and unlikely sexually transmitted disease (STD)]?


a) Yes

b) No

Correct Answer: a) Yes. PID is a polymicrobial infection, with organisms that reflect vaginal and rectal flora as well as STDs. Therefore, the standard treatment regimens are appropriate for both sexually associated and nonsexually associated PID.


6. Male Partner and PID

Since most men do not show symptoms with chlamydia, do we treat a male partner without symptoms ?


a) Yes

b) No

Correct Answer: a) Yes. As per 2010 STD Treatment Guidelines by CDC, untreated asymptomatic male partners are at risk for reinfecting the female index patient, putting her at greater risk for chlamydia-related complications, as well as forming a source for ongoing transmission to other sexual partners.

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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