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Pelvic Inflammatory Disease

Pelvic Inflammatory Disease

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  • 1. Pelvic Inflammatory Disease OB / GYN Rotation LJCMC 25 July 2005 JAMES RATLIFF
  • 2. Table of Topics
    • PID - Pelvic Inflammatory Disease
    • Common Female Infections
    • PID Symptoms
    • PID Common Organisms
    • PID Causative Organism Facts
    • PID Diagnosis
    • PID Consequences
    • Gonococcal Inflammation
    • Chlamydia: Chlamydia trachomatis
    • PID – Douche Frequency
    • PID – Contraception
    • Bibliography
    PID
  • 3. Common Female Infections
  • 4. Pelvic Inflammatory Disease
    • New concept  about 10 years
    • Common term for any inflammation of female genital tract involving pelvic peritoneum
    • Vast majority of genital inflammations
    • Usually involves more than one genital organ
    PID
  • 5. PID - Symptoms
    • Pelvic pain
    • Vaginal discharge
    • Adnexal Tenderness  MC complaint
    • Fever
    PID
  • 6. PID Common Organisms
    • Gonococcus - MCC
    • Chlamydia
    • Enteric Bacteria
    • Puerperal Infections - Post Spontaneous / Induced Abortions / Normal or Abnormal Delivery
      • Staphylocci
      • Streptococci
      • Coliform
      • Clostridium Perfringens
    PID
  • 7. Major Causative Organism Facts
    • Chlamydia-4 million people annually
    • Gonorrhea - 800,000 people annually
    • PID leading cause of preventable infertility
    • Chronic pelvic pain.
    • Potentially fatal ectopic (tubal) pregnancy
    • Ectopic pregnancy - leading cause of first-trimester pregnancy-related deaths in African American women.
    • 70% of chlamydia- and 50% of gonorrhea-infected women asymptomatic
    PID
  • 8. PID Diagnosis
    • Based on Clinical findings
    • Cultures for Organism
    • Ultrasound
    • Laproscopy
    • Biopsy
    PID
  • 9. Consequences of PID
    • General term that refers to infection of upper genital tract:
      • Untreated PID can lead to serious consequences
      • Infertility :1 in 8 become infertile
      • ectopic pregnancy
      • abscess formation
      • chronic pelvic pain.
      • Death
    PID
  • 10. Consequences of PID
    • Peritonitis
    • Adhesions  ileus – Intestional Obstruction
    • Bacteremia  sepsis
    • Endocarditis
    • Meningitis
    • Arthritis
    PID
  • 11. Pelvic Inflammatory Disease with Tubo-Ovarian Complexes Copyright © 1999 by W. B. Saunders Company All rights reserved. Produced in the United States of America ISBN: 0-7216-8462-9
  • 12. PID - Gonorrhea
    • Still the Number One!
    • Transmission exclusively by sexual contact
    • Adult vagina  more resistant
    • Immature vagina  extremely susceptible  immature epithelium
    • Begins in vestibular glands
    • Ascending spread
    • Less obvious in female than male
    PID
  • 13.  
  • 14. PID - Gonorrhea
    • Acute suppurative inflammation
    • Confined mainly to superficial layers
    • Ascending spread
      • Acute salpingitis
      • Salpingo-oophoritis
      • Tubo-ovarian abscess
      • Pyosalpinx
    PID
  • 15. Gonorrhea PID Acute purulent inflammation
  • 16. Tubo-ovarian Abscess PID
  • 17. Gonorrhea Clinical Course
    • ABX – Ceftriaxone DOC
    • Early diagnosis  imperative
    • Usually  chronic resistant condition due to inappropriate treatment
    • Substantial cause of sick-days
    PID
  • 18. Gonococcal Inflammation
    • Usually begins in Bartholin / Vestibular / Periurethral Glands
    • Cervix involvement common
    • Often Asymptomatic
    • Ascending Spread to include
      • Fallopian Tubes
      • Tubo Ovarian Region
      • Adults More Resistant than Children
    PID
  • 19. Gonorrhea Complications
    • Intratubal adhesions
      • Follicular inflammation
      • Glandular inflammation
    • Infection subsides
      • Hydrosalpinx
      • Obliteration  extrauterine gravidity
      • Sterility
    • Rare chronic gonorrhea
      • Purulent arthritis  metastasis
    PID
  • 20. Gonoccoccal Morphology
    • Inflammatory Changes Occur 2 to 7 Days post exposure
    • Largely Confined to Superficial Mucosa and Underlying Submucosa
    • Culture Required to Confirm
    • Smear will show G- Diplococcus
    • Endometrium Usually Spared in Spread
    PID
  • 21. Gonoccoccal Morphology
    • Tubal Involvement causes Acute Suppurative Salpingitis – filling with a purulent exudate
    • In days to weeks the Fimbriae may become Sealed to the Ovary resulting in Salpingo-OOphoritis
    • Tubo-Ovarian Abcess
    • Pyosalpinx ( Tubal Lumen Abcess)
    PID
  • 22. Chlamydia: Chlamydia trachomatis
    • L1-L3 immunotype
      • Lymphogranuloma Venereum
        • Complications
          • Perirectal abscess
          • Perianal Fistula
          • Women develop fistula between vagina and rectum
    PID
  • 23. Chlamydia: Facts
    • 1 in 20 teenage girls and women
    • > 2 % of the general population infected
    • 2003, 877,478 cases of chlamydia were reported in the United States, making it the most commonly reported STI
    PID
  • 24. Chlamydia: Chlamydia trachomatis
    • L1-L3 immunotype
      • Lymphogranuloma Venereum
        • Sexually transmitted infection
        • Rare in the United States
        • Lab
          • Culture
          • Biopsy the node aspirate
          • Complement titer > 1:64
    PID
  • 25. Chlamydia: Chlamydia trachomatis
    • L1-L3 immunotype
      • Lymphogranuloma Venereum
        • Symptoms
        • Fever
        • Chills
        • Headache
        • Myalgias
        • Arthralgia
    PID
  • 26. Chlamydia: Chlamydia trachomatis
    • L1-L3 immunotype
      • Lymphogranuloma Venereum
        • Tetracycline [contraindicated in pregnancy]
        • Erythromycin [DOC in pregnancy]
        • Abx Tx for 21 days
    PID
  • 27. Chlamydia: Chlamydia trachomatis
    • L1-L3 immunotype
      • Lymphogranuloma Venereum
          • Genital Lesions- Usually small painless vesicle that disappears quickly and often goes unnoticed
          • Rectal lesion or inflammation of the rectum [proctitis]
          • Inguinal syndrome
            • Painful Inguinal Lymphadenopathy
            • Most often unilateral
    PID
  • 28. Chlamydia: Chlamydia trachomatis
    • D-K immunotype
      • Cervicitis –
        • Vaginal discharge ay be profuse/ odor
        • persistent
        • gray, white or yellow color
        • Abnormal vaginal bleeding
          • after intercourse
          • between periods
        • A sense of pelvic pressure
        • Painful sexual intercourse
    PID
  • 29. Chlamydia: Chlamydia trachomatis
    • D-K immunotype
    • Complications
      • Pelvic inflammatory disease [PID]
      • Infertility
      • Salpingitis – inflammation of the fallopian tubes
      • Preterm labor
      • Transmission to newborn via the birth canal
        • Chlamydia conjunctivitis
        • Neonatal pneumonia
    PID
  • 30. Chlamydia: Chlamydia trachomatis
    • D-K immunotype
      • Symptoms in Women
        • Cervicitis
        • Vaginal discharge
        • Pelvic pain
        • Untreated may persist for months
        • Usually asymptomatic Urethritis
        • Persistent dsyuria
    PID
  • 31.
    • D-K immunotype
      • Lab
        • Chlamydia culture
          • Not routinely performed
      • Ligase chain reaction
      • Urinalysis test
    Chlamydia: Chlamydia trachomatis PID
  • 32. Chlamydia: Chlamydia trachomatis
    • D-K immunotype
    • Pneumonia in a newborn due to chlamydial infection is most likely acquired during the passage through the birth canal at vaginal delivery
    PID
  • 33. Chlamydia: Chlamydia trachomatis
    • D-K immunotype
    • Newborn pneumonia
      • Appears 2-12 weeks after birth
      • Most common cause of neonatal pneumonia
      • Characterized by a staccato cough
      • Usually no fever
      • Tachypnea [rapid breathing]
    PID
  • 34. PID and Douche Frequency
    • Women who douche once or twice a month may be more likely to have PID than those who douche less than once a month.
    • Douching may push bacteria into the upper genital tract.
    • Douching also may ease discharge caused by an infection, so the woman delays seeking health care
    PID
  • 35. PID - Contraception
    • Depo Provera Appears to Increase Risk for Chlamydial and Gonococcal Infections
    • Women using DMPA had approximately 3½ times the risk of developing a chlamydia or gonorrhea infection than did women who were not using a hormonal contraceptive.
    PID
  • 36. Bibliography
    • G:Pathology slidesWebPathRobbins
    • http://pathcuric1.swmed.edu/
    • http://www.nlm.nih.gov/medlineplus/news/fullstory_25750.htm
    • http://www.nih.gov/news/pr/aug2004/nichd-23.htm
    • http://www.ashastd.org/advocacy/wompos.html
    • http://www.niaid.nih.gov/factsheets/stdpid.htm
    PID