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Q1: Define PID and name the classical organisms (2 min)
PID is an ascending, polymicrobial infection of the upper female genital tract — endometritis, salpingitis, oophoritis and pelvic peritonitis. Classical organisms are Chlamydia trachomatis and Neisseria gonorrhoeae; Mycoplasma genitalium, anaerobes and bacterial-vaginosis organisms also contribute. Up to two-thirds of cases are subclinical (silent PID).
Q2: Describe the pathophysiology — how does chlamydia damage the tube? (3 min)
Organisms colonise cervical columnar epithelium (chlamydia intracellular; gonococcus via pili, Opa, IgA protease) then ascend during menstruation, intercourse, douching or instrumentation to cause endometritis then salpingitis. Chlamydial heat-shock protein 60 drives a TH1/TH17 cell-mediated response (IFN-gamma, TNF-alpha) that fibroses and destroys the ciliated tubal epithelium and fimbriae — the structural basis of tubal infertility, ectopic pregnancy and chronic pelvic pain. Spread to the ovary/peritoneum causes TOA; capsular tracking up the right paracolic gutter causes Fitz-Hugh-Curtis perihepatitis.
Q3: What is the minimum CDC criterion for empirical treatment, and why treat before NAAT results? (2 min)
Cervical motion, uterine or adnexal tenderness on bimanual examination in a sexually active young woman with pelvic pain and no other cause. Delay increases tubal scarring and infertility; the NAAT may be negative in true PID.
Q4: Give the CDC 2021 outpatient regimen and the admission criteria (3 min)
Outpatient: ceftriaxone 500 mg IM once (1 g if 150 kg+) + doxycycline 100 mg BD 14 days + metronidazole 500 mg BD 14 days (metronidazole routine since 2021). Admit (SPIT-A): surgical mimic not excluded, Pregnancy, Illness/severe, cannot Tolerate/adhere, Absent response to oral therapy at 48-72 hours.
Q5: Long-term complications and how do you reduce recurrence? (2 min)
Infertility (cumulative — about 12 / 25 / over 50 percent after 1 / 2 / 3+ episodes), ectopic (6 to 10-fold), chronic pelvic pain, TOA, Fitz-Hugh-Curtis. Reduce recurrence by treating partners of the preceding 60 days, abstinence until both treated, rescreening NAAT at 3 months, condom counselling, and avoiding douching.