Pelvic inflammatory disease by mahmoud abass alawny

1. Department of obstetrics and gynecology
Head of the department : L. Markin, MD, Dr. of Med. Sc.,
Prof.
Name : mahmoud abbass alawny
Course : 4th
Group : 7th
Topic : INFLAMMATORY DISEASES OF THE FEMALE
SEXUAL ORGANS

2. INFLAMMATORY DISEASES OF THE FEMALE SEXUAL ORGANS ( Pelvic
inflammatory disease (PID) )
 Pelvic inflammatory disease (PID) is an infection of
the female reproductive organs. It usually occurs when
sexually transmitted bacteria spread from vagina to
uterus, fallopian tubes or ovaries.
 Normal vaginal microflora contains: Lactobacillus
(70-90%), Staphylococcus epidermalis (30-60%),
diphteroids (30-60%), Hemolytic Streptococci (10-
20%), nonhaemolytic streptococci (5-30%),
Escherichia coli (20-25%), Bacteroides (5-15%),
Peptococcus (10-60%), Peptostreptococcus (10-40%),
Clostridium (5-15%).

3. Common Signs and Symptoms of
Pelvic Inflammatory Disease
 Pain in lower abdomen and pelvis
 Heavy vaginal discharge with an unpleasant odor
 Abnormal uterine bleeding, especially during or after
intercourse, or between menstrual cycles
 Pain or bleeding during intercourse
 Fever, sometimes with chills
 Painful or difficult urination

4. Bartholinitis
 is inflammation of one or both of the two Bartholin's glands,
which are located one on either side of the opening of the
vagina, behind the labia (lips). The inflammation is
sometimes due to germs picked up during sex, but in many
cases the inflammation is not sexually transmitted
 Causes : Staphylococci , Streptoccci , Coliforms ,
gonococcus
 Symptoms : pain and soreness in the region of one of the
labia minora , swelling in the same area , possibly a
slight discharge
 Treatment & Management : antibiotics should be started
immediately prior to incision and drainage.
Drugs : lidocaine 2% ointment , ceftriaxone ,

5. Vulvovaginitis
 is a general term referring to many types of vaginal infection,
although we will talk on the following disorders, which affect the
vulvar region: Vulvovaginal candidiasis, Atrophic vaginitis, Vulvar
vestibulitis, Contact dermatitis .
 Signs and symptoms : Vulvar pruritus and burning , Erythema
and edema of the vestibule and of the labia majora and minora ,
Irritation and pain , discharge .
 Treatment & Management :
Vulvovaginal candidiasis : Butoconazole , Hydrocortisone topical
Atrophic vaginitis : topical vaginal estrogen for 1-2 weeks
Vulvar vestibulitis: no specific cure is available
Contact dermatitis : Hydrocortisone (0.5-1%) and fluorinated
corticosteroids in lotions or creams .

6. Cervicitis
 Cervicitis is an inflammation of the uterine cervix,
characteristically diagnosed by: (1) a visible, purulent or
mucopurulent endocervical exudate in the endocervical
canal or on an endocervical swab specimen and/or
(2) sustained
 Signs and symptoms : Dyspareunia, discharge, bleeding,
burning, itching, odor, pelvic pain .
 Treatment & Management :
Ceftriaxone
Acyclovir
Topical Podofilox
Topical Tinidazole

7. Endometritis
 Endometritis is inflammation of the endometrial lining of
the uterus. In addition to the endometrium, inflammation
may involve the myometrium and, occasionally, the
parametrium.
 Signs and symptoms : Fever, uterine tenderness, abdominal
pain, leukocytosis
 Treatment & Management : antibiotic therapy
A combination of Ampicillin and Aminoglycoside .
A combination of Clindamycin with Gentamicin
or Metronidasol with Unasyn .
In some cases uterine curettage is performed after
temperature normalization.

8. SPECIFIC INFLAMMATORY
DISEASES
 According to the WHO’s classification, there are 21 such
diseases.
Classic venereal diseases
 Nosology Microorganism
 1. Syphilis Treponema pallidum
 2. Gonorrhea Neisseria gonorrhoeae
 3. Chancroid Hemophilus ducrei
 4. Lymphogranuloma venereum Chlamydia trachomatis
 5. granuloma inguinale Callimmantobacterium granulomatis
3,4,5 are mostly in tropic countries

9. Nosology Microorganism
A — that affect mostly genital tract
 1. Syphilis Treponema pallidum
 1. Urogenital chlamydiasis Chlamydia trachomatis
 2. Urogenital trichomoniasis Trichomonas vaginalis
 3. Urogenital mycoplasmosis Mykoplasma hominis
 4. Candidosis vulvovaginitis Candida albicans
 5. Genital herpes Herpes simplex virus
 6. Genital warts Papillomavirus hominis
 7. Molluscum contagiosum Molluscovirus hominis
 8. Bacterial vaginosis Gardnerella vaginalis та iншi збудники
 9. Urogenital shigellosis of homosexualists Shigella species
 10. Pediculosis pubis Phthyrus pubis
 11. Scabies Sarcoptes scabiei
B — With mostly affection of other organs
 1. Infection, caused by HIV Human immunodeficiency virus
 2. Hepatitis B Hepatitis B virus
 3. Cytomegalovirus infection Cytomegalovirus hominis
 4. Amebiasis Entamoeba hystolytica
 5. Lambliosis Giardia lamblia

10. Gonorrhea
 is a sexually transmitted infection (STI) caused by the
bacterium Neisseria gonorrhoeae. Many of those infected
have no symptoms. Incubational period lasts for 2-14 days,
Clinic forms of gonorrhea depends on the localization of the
process : Gonococcal urethritis, Bartholinitis,
endocervicitis, proctitis, endometritis, salpingitis,
pelvioperitonitis,
 Signs and symptoms : in men burning with urination,
discharge from the penis, or testicular pain
in women : vaginal discharge, lower abdominal pain,
or pain with sexual intercourse
 Treatment & Management : Antibiotics such as
Ciprofloxacin, Doxycyclin, Trobicyn, Cephtriaxon, Afloxacin
in combination with Metronidazol, Tiberal, Naxogyn should
be prescribed.

11. Urogenital trichomoniasis
 is a sexually transmitted infection (STI) caused by the motile
parasitic protozoan Trichomonas vaginalis. most often spread
through vaginal, oral, or anal sex. About 70% of women and
men do not have symptoms when infected.
 Signs and symptoms : pain, burning or itching in the penis,
urethra , or vagina, increased during intercourse and
urination. a yellow-green, itchy, frothy, foul-smelling vaginal
discharge .
 Treatment & Management :
Antiprotozoal agents : Metronidazole (Flagyl) Single-dose
therapy with 2 g orally and 500 mg twice daily for 7 days.
or Tinidazole (Tindamax) single oral 2-g dose taken with
food and 150 mg twice daily for 7 days.

12. Urogenital chlamydiosis
 Is a sexually transmitted infection caused by the bacterium
Chlamydia trachomatis. Approximately 50% of infected males
and 80% of infected females are asymptomatic.
Chlamydia can be spread during vaginal, anal, or oral sex,
and can be passed from an infected mother to baby
during childbirth. The eye infections may also be spread by
personal contact, flies, and contaminated towels in areas
with poor sanitation.
 Signs and symptoms : None, vaginal discharge, Yellow
discharge from the penis, burning with urination, Fever .
 Treatment & Management :
Antibiotics : Ofloxacin, Erythromycin, or Azithromycin

13. Urogenital mycoplasmosis
 The Microbal agents are Mycoplasma hominis, Mycoplasma
genitaloum, Ureaplasma urealiticum. Is transmitted sexually
and they are highly spread among the population. can occur
in acute and chronic form, and has no symptoms .
The agents may be activated under the influence of
menstruation, oral contraceptives, pregnancy, delivery.
 Treatment & Management :
oral tetracycline for 7 days
Clindamycin or Clarithromycin is an alternative treatment
for tetracycline-resistant M hominis

14. Herpesvirus infection
 Is caused by Herpes simplex virus, mostly of the second type
(HSV-2). Source of the infection are infected persons and
carriers. It can be transmitted during urogenital contact. The
virus is located mostly in mucos membranes of urogenital
tract in men and cervical canal in women . The incubation
period is 3-7 days.
 Signs and symptoms : High temperature (102-104°F),
Anorexia, fever, headache, malaise, and myalgia, Local
symptoms include pain, itching, dysuria, vaginal and
urethral discharge, and tender lymphadenopathy.
Herpetic vesicles appear on the external genitalia, labia majora,
labia minora, vaginal vestibule, and introitus.
 Treatment & Management : Penciclovir 0.1% apply q2hr
while awake for 4 days

15. Condyloma acuminata
 an epidermal manifestation attributed to the epidermotropic
human papillomavirus (HPV) 16 and 18 types,
 Signs and symptoms : Eruptions may appear pearly, filiform,
fungating, cauliflower, or plaquelike. They can be smooth,
verrucous, or lobulated.
difficulties at walking, intercourse, During pregnancy and
delivery they can cause bleeding.
 Treatment & Management : If genital warts are large, laser
vaporization is performed.
Podophyllum resin : 25% for 1-4 hr depending on condition of
lesion .
Interferon alfa-n3 : 250,000 million unit/mL per wart
intralesional inj 2 times/week up to 8 weeks
Kunecatechins ; 15% Apply topically q8hr

16. Pelvic Inflammatory
Disease Workup
is often based on clinical criteria, with or without additional
laboratory and imaging evidence.
Procedures :
 Laparoscopic confirmation
 Transvaginal ultrasonographic scanning or magnetic
resonance imaging (MRI) showing thickened, fluid-filled
tubes with or without free pelvic fluid or tubo-ovarian
abscess (TOA)
 Endometrial biopsy showing endometritis.

17. Pelvic Inflammatory
Disease Workup
criteria that improve diagnostic specificity include the
following:
 Oral temperature higher than 38.3° C (101° F)
 Abnormal cervical or vaginal mucopurulent discharge
 Abundant white blood cells (WBCs) on saline microscopy of
vaginal secretions
 Elevated erythrocyte sedimentation rate (ESR) (≥40 mm/h)
 Elevated C-reactive protein (CRP) level (≥ 60 mg/L)
 Laboratory evidence of infection obtaining a sample from
patient