Question.

A young woman presents with a recurrence of her pelvic inflammatory disease (PID). Which one of the following is FALSE regarding this presentation?

a. Group B streptococcus is the most common cause

b. Chlamydia and gonorrhoea may be vertically transmitted

c. The risk of ectopic pregnancy is increased

d. She may also complain of right upper quadrant pain

e. Tubo-ovarian abscess is a complication

 

Answer.

The answer is a. Group B streptococcus is a rare cause of PID.

Explanation.

Pelvic inflammatory disease (PID) describes infection of the female upper genital tract (uterus, fallopian tubes and ovaries).

It results from ascending infection from sexually transmitted pathogens with Chlamydia trachomatis the most frequent causative pathogen; gonorrhoea is on the rise and becoming more common as a cause of PID. Many cases are polymicrobial.

Transmission of an infectious disease from mother to baby, either across the placenta or during childbirth is called vertical transmission. The classic vertically transmitted infections are the TORCH infections (though there are many more):

 

  • Toxoplasmosis
  • Other (chlamydia, gonorrhoea, Group B streptococcus)
  • Rubella
  • Cytomegalovirus, Chickenpox (VZV)
  • Herpes simplex virus

Scarring of the fallopian tubes from chronic PID increases the risk of both infertility and ectopic pregnancy. Other complications are tubo-ovarian abscess and sepsis.

An often overlooked complication of PID is transabdominal spread causing perihepatitis (the Fitz-Hugh-Curtis syndrome) which gives right upper quadrant pain and signs of systemic inflammation.

 

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