Pelvic inflammatory disease is ascending infection from the endocervix. There are two main groups of organisms involved. These are STIs and commensals of the female genital tract
Dr. Jaideep Malhotra is an IVF specialist based in Agra, India. He has over 50 published papers and 100 conference presentations. He is a fellow of many Indian and international obstetrics and gynecology organizations. He has received several awards for his work, including producing India's first IVF birth and test tube baby of Nepal. He practices at his nursing home in Agra and is a consulting IVF specialist at multiple other locations in Northern India and Nepal.
This presentation discusses the basics and updates about the assessment and management of chronic pelvic female in women. It highlights the recent thoughts about the biopsychosocial model of chronic pelvic pain. It provides an algorithm that joins the management between primary and tertiary care in the management of CPP.
Pelvic inflammatory disease (PID) is an inflammatory condition of the female upper genital tract that can involve the endometrium, fallopian tubes, and pelvic tissue. It is usually caused by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis transmitted sexually. Left untreated, PID can lead to long-term complications like infertility or ectopic pregnancy. Treatment involves antibiotics, with hospitalization sometimes needed for severe or unresponsive cases. Prompt treatment is important to prevent permanent damage.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, often attaching to other organs. It is a common disease among women of childbearing age that causes pain and sometimes infertility. While its exact causes are unknown, endometriosis is thought to be due to retrograde menstruation or genetic/immune factors. It has no cure and is diagnosed through laparoscopy, though various hormone treatments, surgery, pregnancy, and alternative therapies can help manage symptoms. Endometriosis can range from minimal to severe depending on the extent and location of tissue growth outside the uterus.
The document provides an overview of endometriosis, including its introduction, epidemiology, risk factors, sites, theories of pathogenesis, clinical features, types, and impact on fertility. It describes endometriosis as the presence of endometrial tissue outside the uterus, most commonly involving the ovaries, pelvic peritoneum, and deep infiltrating sites. Retrograde menstruation and coelomic metaplasia are discussed as theories for how it develops. Clinical features include pelvic pain and infertility.
This document discusses the management of endometriosis. It defines endometriosis as tissue similar to the endometrium found outside the uterus, causing inflammation. Common symptoms include severe menstrual pain, pain during or after sex, chronic pelvic pain, and infertility. Diagnosis is typically via laparoscopy, which allows visualization and staging of lesions. Treatment involves surgery to remove lesions and adhesions or drain endometriomas, along with medical therapy using hormones to suppress the endometrial tissue. Goals of treatment are pain relief and improving fertility.
Dr. Jaideep Malhotra is an IVF specialist based in Agra, India. He has over 50 published papers and 100 conference presentations. He is a fellow of many Indian and international obstetrics and gynecology organizations. He has received several awards for his work, including producing India's first IVF birth and test tube baby of Nepal. He practices at his nursing home in Agra and is a consulting IVF specialist at multiple other locations in Northern India and Nepal.
This presentation discusses the basics and updates about the assessment and management of chronic pelvic female in women. It highlights the recent thoughts about the biopsychosocial model of chronic pelvic pain. It provides an algorithm that joins the management between primary and tertiary care in the management of CPP.
Pelvic inflammatory disease (PID) is an inflammatory condition of the female upper genital tract that can involve the endometrium, fallopian tubes, and pelvic tissue. It is usually caused by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis transmitted sexually. Left untreated, PID can lead to long-term complications like infertility or ectopic pregnancy. Treatment involves antibiotics, with hospitalization sometimes needed for severe or unresponsive cases. Prompt treatment is important to prevent permanent damage.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, often attaching to other organs. It is a common disease among women of childbearing age that causes pain and sometimes infertility. While its exact causes are unknown, endometriosis is thought to be due to retrograde menstruation or genetic/immune factors. It has no cure and is diagnosed through laparoscopy, though various hormone treatments, surgery, pregnancy, and alternative therapies can help manage symptoms. Endometriosis can range from minimal to severe depending on the extent and location of tissue growth outside the uterus.
The document provides an overview of endometriosis, including its introduction, epidemiology, risk factors, sites, theories of pathogenesis, clinical features, types, and impact on fertility. It describes endometriosis as the presence of endometrial tissue outside the uterus, most commonly involving the ovaries, pelvic peritoneum, and deep infiltrating sites. Retrograde menstruation and coelomic metaplasia are discussed as theories for how it develops. Clinical features include pelvic pain and infertility.
This document discusses the management of endometriosis. It defines endometriosis as tissue similar to the endometrium found outside the uterus, causing inflammation. Common symptoms include severe menstrual pain, pain during or after sex, chronic pelvic pain, and infertility. Diagnosis is typically via laparoscopy, which allows visualization and staging of lesions. Treatment involves surgery to remove lesions and adhesions or drain endometriomas, along with medical therapy using hormones to suppress the endometrial tissue. Goals of treatment are pain relief and improving fertility.
Genital tb in infertility & our experience dr. sharda jain, dr. jyoti agarwal...Lifecare Centre
This document discusses genital tuberculosis (TB) and the authors' experience with diagnosing and treating it. Some key points:
- Genital TB is a significant cause of infertility in India, contributing to around 35-60% of infertility cases seen by the authors.
- Diagnosing latent or asymptomatic genital TB poses a major challenge as conventional tests only detect 15-20% of cases.
- The authors have found interferon gamma tests, MTBC tests, and TB PCR on endometrial biopsies and fluids to be helpful in diagnosing more cases.
- Laparoscopy and hysteroscopy also provide diagnostic information. The authors' laparoscopy findings have ranged from tub
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Endometrial hyperplasia is an increased proliferation of endometrial glands relative to the stroma that can progress to endometrial carcinoma. It occurs most often in peri-menopausal women with elevated estrogen levels and is caused by prolonged, unopposed estrogen stimulation. Endometrial hyperplasia is classified as simple, complex, or atypical depending on architectural and cytological abnormalities. Endometrial carcinoma is the most common cancer of the female reproductive system, occurring most often in post-menopausal women. It is broadly classified into Type I and Type II tumors based on clinical and molecular characteristics and risk factors. Surgery is the primary treatment for early-stage disease while radiation and chemotherapy may be used
Adenomyosis is a benign condition where endometrial tissue grows into the myometrium. It causes the uterus to enlarge asymmetrically, especially on the posterior wall. Women with adenomyosis typically experience heavy menstrual bleeding and painful periods that can occur throughout the month. Ultrasound and MRI can detect adenomyosis by showing cysts in the thickened myometrium and an indistinct endomyometrial junction. Treatment depends on a woman's age and fertility desires, ranging from medication like NSAIDs and oral contraceptives to hysterectomy for older, parous women.
2-medical treatment of endometrial hyperplasia and endometrial cancerBasalama Ali
This document discusses the medical treatment of endometrial hyperplasia and endometrial cancer. It provides information on diagnosis, treatment recommendations, staging, and prognosis. For endometrial hyperplasia with atypia, hysterectomy is the treatment of choice for women who don't want future pregnancies. Progestin therapy can treat hyperplasia without atypia. The most common symptom of endometrial cancer is vaginal bleeding or discharge. Staging and grading help determine prognosis and treatment. The cornerstone treatment is hysterectomy and bilateral salpingo-oophorectomy. Follow up care is important to monitor for recurrence.
Pelvic inflammatory disease (PID) is caused by ascending infections from the cervix by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis. It causes inflammation of the female reproductive organs within the pelvis. Symptoms include pelvic pain and abnormal vaginal bleeding or discharge. Diagnosis is based on clinical features and confirmed through tests and imaging. Treatment involves antibiotics and sometimes surgery to drain abscesses. Untreated PID can lead to serious long-term complications like infertility.
Endometriosis is a disease where endometrial tissue grows outside the uterus, most commonly in the pelvis. It can cause pelvic pain, infertility, and other symptoms. Treatment involves surgery to remove lesions and adhesions, as well as medical therapy using hormones to suppress ovarian function and estrogen production. Newer medical treatments targeting aromatase and local estrogen production are also showing promise for reducing endometriosis-associated pain.
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
This document discusses Pelvic Inflammatory Disease (PID), including its definition, causes, risk factors, types (acute and chronic), symptoms, signs, investigations, differential diagnoses, management, and treatment. PID is an infection of the female upper genital tract caused by bacteria that enter through the cervix. The most common causes are Chlamydia trachomatis and Neisseria gonorrhoeae. Without treatment, PID can lead to long-term complications like infertility and ectopic pregnancy. Management involves antibiotic therapy and treating sexual partners to prevent reinfection.
Benign cervical diseases are common but malignancy must be ruled out. Cervical cancer develops from premalignant cervical intraepithelial neoplasia over years. Screening for premalignant cervical disease significantly reduces cervical cancer deaths by detecting cervical intraepithelial neoplasia, which is then diagnosed and treated through colposcopy.
This document summarizes guidelines for managing ovarian endometriomas. It discusses that endometriomas larger than 3cm should be surgically removed if causing pain or infertility. Complete excision of the cyst is preferable to drainage/ablation to reduce recurrence risk. While surgery provides relief, recurrence rates remain high, so post-operative hormonal therapy for 6 months can help delay recurrence compared to no treatment. Ovarian damage is a risk, so conservative surgery aims to preserve ovarian function where possible.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and surrounding pelvic structures. It is usually caused by sexually transmitted infections like chlamydia and gonorrhea spreading from the vagina or cervix. Left untreated, PID can cause long-term complications like infertility, ectopic pregnancy, and chronic pelvic pain. Treatment involves antibiotics to cover the most common causative organisms.
This document defines chronic pelvic pain as noncyclic pain lasting at least 6 months in the pelvis, lower abdomen, or lower back that causes functional disability requiring medical or surgical treatment. Potential causes of chronic pelvic pain include endometriosis, adenomyosis, uterine prolapse, fibroids, ovarian cysts, and pelvic adhesions. Symptoms may include intermenstrual pain, dysmenorrhea, premenstrual syndrome, and pelvic congestion syndrome. Diagnostic tests include blood tests, endometrial biopsy, transvaginal ultrasound, cystoscopy, and laparoscopy. Treatment involves a multidisciplinary approach including removing identifiable pathology, medications like NSAIDs, TCAs, and
Pelvic inflammatory disease is caused by infections like chlamydia and gonorrhea that spread from the cervix to the fallopian tubes and other female reproductive organs. Left untreated, it can cause tubal scarring and blockages leading to ectopic pregnancy or infertility. Symptoms include abdominal and pelvic pain, abnormal bleeding, and discharge. Treatment involves antibiotics to treat the infection. For severe cases, patients may need to be hospitalized.
1) Adenomyosis is characterized by ectopic endometrial tissue within the myometrium and prevalence increases with age and multiparity.
2) It can contribute to infertility by impairing sperm transport and destruction of the myometrial architecture.
3) MRI is more specific than transvaginal ultrasound in diagnosing adenomyosis based on junctional zone thickness measurements.
4) Prolonged GnRH agonist treatment prior to IVF was found to minimize any adverse effects of adenomyosis on implantation and pregnancy rates.
5) The LNG-IUS and UAE show promise in effectively treating adenomyosis symptoms like heavy bleeding and pain.
Puberty menorrhagia Dr Sharda Jain , Dr Jyoti Agarwal Lifecare Centre
Puberty menorrhagia refers to heavy menstrual bleeding lasting longer than 7 days or exceeding 80 ml of blood loss during puberty. Common causes include dysfunctional uterine bleeding due to immature hypothalamic-pituitary-ovarian axis, bleeding disorders, polycystic ovary syndrome, and complications of pregnancy. Evaluation involves detailed history, physical exam, ultrasound, blood counts, pregnancy test, and tests for underlying causes as needed. Treatment is usually medical, focusing on controlling bleeding through hemostatic agents like tranexamic acid or desmopressin, correcting anemia, and treating any underlying disorders found. Surgery is rarely needed.
Endometriosis is a benign condition where endometrial tissue grows outside the uterine cavity, most commonly on the ovaries, pouch of Douglas, uterosacral ligaments, and rectovaginal septum. It causes pain and infertility and is diagnosed through laparoscopy or imaging like ultrasound and MRI. Treatment options include expectant management for mild cases, medical therapy using hormones to induce endometrial atrophy, and surgery to destroy endometrial lesions laparoscopically or through hysterectomy. Combined medical and surgical treatment may also be used.
This document discusses the evaluation and management of acute abdomen during pregnancy. It outlines common etiologies including appendicitis, bowel obstruction, and pregnancy-related causes. The evaluation involves history, physical exam focusing on signs of peritonitis, and lab tests. Imaging options like ultrasound and MRI are discussed. Laparoscopy is generally safe in pregnancy with precautions. Acute appendicitis is the most common non-obstetric surgical emergency. It can be more severe in pregnancy and risks increase with delayed treatment.
This document discusses adenomyosis, including its definition, pathogenesis, clinical presentation, diagnostic modalities, and treatment options. Adenomyosis is defined as the benign invasion of endometrial glands and stroma into the myometrium. It most commonly presents in women aged 30-45 with symptoms like dysmenorrhea, heavy menstrual bleeding, and dyspareunia. Diagnosis can be made using ultrasound, MRI, or biopsy. Treatment involves conservative management, medical therapy like progestins or GnRH agonists, or surgical options such as hysterectomy or uterine-sparing procedures.
Genital tuberculosis is a major health problem in developing countries. It spreads hematogenously from a primary pulmonary infection to the fallopian tubes. Clinical features include infertility, chronic pelvic pain, and menstrual abnormalities. Diagnosis involves blood tests, imaging, endometrial biopsy, and laparoscopy. Treatment consists of a multi-drug chemotherapy regimen for 9-12 months. Prognosis is good for cure but fertility is often not restored due to tubal damage. Surgery may be needed for complications like pyosalpinx but does not improve fertility.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is usually caused by sexually transmitted pathogens like Chlamydia trachomatis and Neisseria gonorrhoeae. It is diagnosed clinically based on symptoms of pelvic or lower abdominal pain along with cervical motion tenderness and can be confirmed with laparoscopy. Treatment involves broad-spectrum antibiotics to cover common causes. Complications include infertility, ectopic pregnancy, and chronic pelvic pain if left untreated. Prevention focuses on sexual health education, screening, and prompt treatment of infections.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and ovaries. It is usually caused by sexually transmitted infections like Chlamydia trachomatis and Neisseria gonorrhoeae spreading from the cervix. Left untreated, PID can cause long-term complications like chronic pelvic pain, infertility, and ectopic pregnancy. Treatment involves antibiotics to eradicate the infection as well as counseling to prevent future occurrences.
Genital tb in infertility & our experience dr. sharda jain, dr. jyoti agarwal...Lifecare Centre
This document discusses genital tuberculosis (TB) and the authors' experience with diagnosing and treating it. Some key points:
- Genital TB is a significant cause of infertility in India, contributing to around 35-60% of infertility cases seen by the authors.
- Diagnosing latent or asymptomatic genital TB poses a major challenge as conventional tests only detect 15-20% of cases.
- The authors have found interferon gamma tests, MTBC tests, and TB PCR on endometrial biopsies and fluids to be helpful in diagnosing more cases.
- Laparoscopy and hysteroscopy also provide diagnostic information. The authors' laparoscopy findings have ranged from tub
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Endometrial hyperplasia is an increased proliferation of endometrial glands relative to the stroma that can progress to endometrial carcinoma. It occurs most often in peri-menopausal women with elevated estrogen levels and is caused by prolonged, unopposed estrogen stimulation. Endometrial hyperplasia is classified as simple, complex, or atypical depending on architectural and cytological abnormalities. Endometrial carcinoma is the most common cancer of the female reproductive system, occurring most often in post-menopausal women. It is broadly classified into Type I and Type II tumors based on clinical and molecular characteristics and risk factors. Surgery is the primary treatment for early-stage disease while radiation and chemotherapy may be used
Adenomyosis is a benign condition where endometrial tissue grows into the myometrium. It causes the uterus to enlarge asymmetrically, especially on the posterior wall. Women with adenomyosis typically experience heavy menstrual bleeding and painful periods that can occur throughout the month. Ultrasound and MRI can detect adenomyosis by showing cysts in the thickened myometrium and an indistinct endomyometrial junction. Treatment depends on a woman's age and fertility desires, ranging from medication like NSAIDs and oral contraceptives to hysterectomy for older, parous women.
2-medical treatment of endometrial hyperplasia and endometrial cancerBasalama Ali
This document discusses the medical treatment of endometrial hyperplasia and endometrial cancer. It provides information on diagnosis, treatment recommendations, staging, and prognosis. For endometrial hyperplasia with atypia, hysterectomy is the treatment of choice for women who don't want future pregnancies. Progestin therapy can treat hyperplasia without atypia. The most common symptom of endometrial cancer is vaginal bleeding or discharge. Staging and grading help determine prognosis and treatment. The cornerstone treatment is hysterectomy and bilateral salpingo-oophorectomy. Follow up care is important to monitor for recurrence.
Pelvic inflammatory disease (PID) is caused by ascending infections from the cervix by bacteria like Neisseria gonorrhoeae and Chlamydia trachomatis. It causes inflammation of the female reproductive organs within the pelvis. Symptoms include pelvic pain and abnormal vaginal bleeding or discharge. Diagnosis is based on clinical features and confirmed through tests and imaging. Treatment involves antibiotics and sometimes surgery to drain abscesses. Untreated PID can lead to serious long-term complications like infertility.
Endometriosis is a disease where endometrial tissue grows outside the uterus, most commonly in the pelvis. It can cause pelvic pain, infertility, and other symptoms. Treatment involves surgery to remove lesions and adhesions, as well as medical therapy using hormones to suppress ovarian function and estrogen production. Newer medical treatments targeting aromatase and local estrogen production are also showing promise for reducing endometriosis-associated pain.
Endometriosis is known to have a remarkably negative effect on the Quality of Life of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important.
This document discusses Pelvic Inflammatory Disease (PID), including its definition, causes, risk factors, types (acute and chronic), symptoms, signs, investigations, differential diagnoses, management, and treatment. PID is an infection of the female upper genital tract caused by bacteria that enter through the cervix. The most common causes are Chlamydia trachomatis and Neisseria gonorrhoeae. Without treatment, PID can lead to long-term complications like infertility and ectopic pregnancy. Management involves antibiotic therapy and treating sexual partners to prevent reinfection.
Benign cervical diseases are common but malignancy must be ruled out. Cervical cancer develops from premalignant cervical intraepithelial neoplasia over years. Screening for premalignant cervical disease significantly reduces cervical cancer deaths by detecting cervical intraepithelial neoplasia, which is then diagnosed and treated through colposcopy.
This document summarizes guidelines for managing ovarian endometriomas. It discusses that endometriomas larger than 3cm should be surgically removed if causing pain or infertility. Complete excision of the cyst is preferable to drainage/ablation to reduce recurrence risk. While surgery provides relief, recurrence rates remain high, so post-operative hormonal therapy for 6 months can help delay recurrence compared to no treatment. Ovarian damage is a risk, so conservative surgery aims to preserve ovarian function where possible.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and surrounding pelvic structures. It is usually caused by sexually transmitted infections like chlamydia and gonorrhea spreading from the vagina or cervix. Left untreated, PID can cause long-term complications like infertility, ectopic pregnancy, and chronic pelvic pain. Treatment involves antibiotics to cover the most common causative organisms.
This document defines chronic pelvic pain as noncyclic pain lasting at least 6 months in the pelvis, lower abdomen, or lower back that causes functional disability requiring medical or surgical treatment. Potential causes of chronic pelvic pain include endometriosis, adenomyosis, uterine prolapse, fibroids, ovarian cysts, and pelvic adhesions. Symptoms may include intermenstrual pain, dysmenorrhea, premenstrual syndrome, and pelvic congestion syndrome. Diagnostic tests include blood tests, endometrial biopsy, transvaginal ultrasound, cystoscopy, and laparoscopy. Treatment involves a multidisciplinary approach including removing identifiable pathology, medications like NSAIDs, TCAs, and
Pelvic inflammatory disease is caused by infections like chlamydia and gonorrhea that spread from the cervix to the fallopian tubes and other female reproductive organs. Left untreated, it can cause tubal scarring and blockages leading to ectopic pregnancy or infertility. Symptoms include abdominal and pelvic pain, abnormal bleeding, and discharge. Treatment involves antibiotics to treat the infection. For severe cases, patients may need to be hospitalized.
1) Adenomyosis is characterized by ectopic endometrial tissue within the myometrium and prevalence increases with age and multiparity.
2) It can contribute to infertility by impairing sperm transport and destruction of the myometrial architecture.
3) MRI is more specific than transvaginal ultrasound in diagnosing adenomyosis based on junctional zone thickness measurements.
4) Prolonged GnRH agonist treatment prior to IVF was found to minimize any adverse effects of adenomyosis on implantation and pregnancy rates.
5) The LNG-IUS and UAE show promise in effectively treating adenomyosis symptoms like heavy bleeding and pain.
Puberty menorrhagia Dr Sharda Jain , Dr Jyoti Agarwal Lifecare Centre
Puberty menorrhagia refers to heavy menstrual bleeding lasting longer than 7 days or exceeding 80 ml of blood loss during puberty. Common causes include dysfunctional uterine bleeding due to immature hypothalamic-pituitary-ovarian axis, bleeding disorders, polycystic ovary syndrome, and complications of pregnancy. Evaluation involves detailed history, physical exam, ultrasound, blood counts, pregnancy test, and tests for underlying causes as needed. Treatment is usually medical, focusing on controlling bleeding through hemostatic agents like tranexamic acid or desmopressin, correcting anemia, and treating any underlying disorders found. Surgery is rarely needed.
Endometriosis is a benign condition where endometrial tissue grows outside the uterine cavity, most commonly on the ovaries, pouch of Douglas, uterosacral ligaments, and rectovaginal septum. It causes pain and infertility and is diagnosed through laparoscopy or imaging like ultrasound and MRI. Treatment options include expectant management for mild cases, medical therapy using hormones to induce endometrial atrophy, and surgery to destroy endometrial lesions laparoscopically or through hysterectomy. Combined medical and surgical treatment may also be used.
This document discusses the evaluation and management of acute abdomen during pregnancy. It outlines common etiologies including appendicitis, bowel obstruction, and pregnancy-related causes. The evaluation involves history, physical exam focusing on signs of peritonitis, and lab tests. Imaging options like ultrasound and MRI are discussed. Laparoscopy is generally safe in pregnancy with precautions. Acute appendicitis is the most common non-obstetric surgical emergency. It can be more severe in pregnancy and risks increase with delayed treatment.
This document discusses adenomyosis, including its definition, pathogenesis, clinical presentation, diagnostic modalities, and treatment options. Adenomyosis is defined as the benign invasion of endometrial glands and stroma into the myometrium. It most commonly presents in women aged 30-45 with symptoms like dysmenorrhea, heavy menstrual bleeding, and dyspareunia. Diagnosis can be made using ultrasound, MRI, or biopsy. Treatment involves conservative management, medical therapy like progestins or GnRH agonists, or surgical options such as hysterectomy or uterine-sparing procedures.
Genital tuberculosis is a major health problem in developing countries. It spreads hematogenously from a primary pulmonary infection to the fallopian tubes. Clinical features include infertility, chronic pelvic pain, and menstrual abnormalities. Diagnosis involves blood tests, imaging, endometrial biopsy, and laparoscopy. Treatment consists of a multi-drug chemotherapy regimen for 9-12 months. Prognosis is good for cure but fertility is often not restored due to tubal damage. Surgery may be needed for complications like pyosalpinx but does not improve fertility.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is usually caused by sexually transmitted pathogens like Chlamydia trachomatis and Neisseria gonorrhoeae. It is diagnosed clinically based on symptoms of pelvic or lower abdominal pain along with cervical motion tenderness and can be confirmed with laparoscopy. Treatment involves broad-spectrum antibiotics to cover common causes. Complications include infertility, ectopic pregnancy, and chronic pelvic pain if left untreated. Prevention focuses on sexual health education, screening, and prompt treatment of infections.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and ovaries. It is usually caused by sexually transmitted infections like Chlamydia trachomatis and Neisseria gonorrhoeae spreading from the cervix. Left untreated, PID can cause long-term complications like chronic pelvic pain, infertility, and ectopic pregnancy. Treatment involves antibiotics to eradicate the infection as well as counseling to prevent future occurrences.
Pelvic Inflammatory Disease- acute and subclinical infection of the upper gen...MariaDavis42
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is commonly caused by untreated sexually transmitted infections like chlamydia and gonorrhea. Common symptoms include pelvic pain and abnormal vaginal discharge. It is diagnosed through medical history, physical exam, tests to detect infections, and imaging. Treatment involves antibiotics to treat the infection and prevent long term complications, which can include infertility, ectopic pregnancy, and chronic pelvic pain if left untreated. Prevention focuses on barrier contraceptive use and early treatment of STIs.
Acutepelvicinflammatorydisease Ahmed Mukhtar Ali ahmed afify
This document provides an overview of acute pelvic inflammatory disease (PID). It discusses what PID is, its epidemiology and risk factors. The main causes are sexually transmitted organisms like Neisseria gonorrhoeae and Chlamydia trachomatis. Diagnosis is based on symptoms and physical exam findings. Treatment involves antibiotics, sometimes hospitalization, to eliminate the infection. Prevention strategies target screening and treatment of sexually transmitted infections.
This document discusses Pelvic Inflammatory Disease (PID), including its definition, causes, risk factors, types (acute and chronic), symptoms, signs, investigations, differential diagnoses, management, and treatment. PID is an infection of the female upper genital tract caused by bacteria that enter through the cervix. The most common causes are Chlamydia trachomatis and Neisseria gonorrhoeae. Without treatment, PID can lead to long-term complications like infertility and ectopic pregnancy. Management involves antibiotic therapy and treating sexual partners to prevent reinfection.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that can cause long-term complications if not treated promptly. It is usually caused by bacteria spreading from the vagina or cervix, such as Chlamydia trachomatis and Neisseria gonorrhoeae. Left untreated, PID can lead to infertility, ectopic pregnancy, chronic pelvic pain, and increased risk of HIV transmission. Treatment involves a combination of antibiotics to cover common causative organisms, with hospitalization recommended for severe cases. Prompt treatment is important to prevent long-term complications.
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that arises from the endocervix and causes inflammation of the endometrium, fallopian tubes, ovaries, and pelvic tissue. It is usually sexually transmitted and can lead to tubal damage and scarring, increasing risks of ectopic pregnancy and infertility. Symptoms include abdominal pain and abnormal bleeding or discharge, but diagnosis can be difficult due to non-specific signs. Treatment involves antibiotics to cure the infection as well as prevent future complications on reproductive health.
This document summarizes guidelines for diagnosing and treating common sexually transmitted infections (STIs) seen in adolescent patients. It provides information on clinical presentation, differential diagnosis, and treatment recommendations for various STIs including chlamydia, gonorrhea, hepatitis, HIV, herpes, syphilis, and others. It also discusses risk factors, screening recommendations, and unique issues in treating adolescent patients for STIs.
Pelvic inflammatory disease (PID) is a major health issue caused by sexually transmitted pathogens ascending from the lower to upper genital tract. It can lead to long-term complications like chronic pelvic pain and infertility. Broad-spectrum antibiotics are used to treat PID, while prevention relies on sex education, barrier methods, screening and contact tracing to curb rising prevalence worldwide. More efforts are needed nationally and locally to improve awareness and access to reproductive healthcare services, especially for adolescents.
Pelvic inflammatory disease (PID) is a major health issue that results from sexually transmitted infections ascending into the female reproductive tract. It can cause long-term complications like infertility and chronic pelvic pain. While antibiotics can treat PID, prevention through education and screening programs may help reduce its prevalence and impact. More comprehensive sex education programs in schools as well as screening and partner treatment initiatives could potentially further curb PID cases.
Based on the history and examination findings, the key differential diagnoses are:
1. PID
2. UTI
3. Endometritis
4. Appendicitis
Investigations:
1. Urine R/E and C/S
2. CBC, CRP, LFT
3. TVS pelvis to look for any pelvic collection/abscess
4. High vaginal swab for microscopy, culture and sensitivity
5. Treat empirically for PID with IV antibiotics like ceftriaxone and metronidazole pending culture reports. Admit for IV antibiotics.
6. Review in 48-72 hours for response to treatment. Consider laparoscopy if no improvement
PID is an infection of the upper female genital tract that is usually caused by sexually transmitted organisms like Neisseria gonorrhoeae and Chlamydia trachomatis. Risk factors include young age, multiple sexual partners, and IUD use. Left untreated, PID can lead to long-term complications like infertility, ectopic pregnancy, and chronic pelvic pain. Diagnosis is based on symptoms and physical exam findings. Treatment involves broad-spectrum antibiotics to eliminate the infection as well as prevent complications. Hospital admission is recommended for severe cases, pregnant women, or when there is no response to oral antibiotics.
Sexually transmitted diseases (STDS) with nursing responsibiltyeducation4227
This document discusses several sexually transmitted diseases (STDs), including their causes, symptoms, diagnostic testing, treatment, and nursing implications. It covers gonorrhea, chlamydia, syphilis, and genital herpes. Key points include that STDs can often present without symptoms, leading to complications if not treated. Screening, partner treatment, education on prevention, and counseling are important for nursing care.
This document discusses several sexually transmitted diseases (STDs) including their causes, transmission, signs and symptoms, diagnostic testing, treatment, and nursing implications. The most common STDs in the Philippines are chlamydia, gonorrhea, genital herpes, HIV/AIDS, and syphilis. STD transmission occurs through sexual contact, blood, or from mother to child. Many STDs initially show few or no symptoms, but can lead to serious complications without treatment such as infertility, ectopic pregnancy, and increased HIV risk. Nursing care involves health education, symptom management, partner treatment, and prevention through limiting sexual partners and condom use.
This document discusses Pelvic Inflammatory Disease (PID), an infection of the female reproductive organs including the uterus, ovaries, and fallopian tubes. PID is caused by bacteria spreading from the vagina or cervix into the upper reproductive organs. Common causes are the sexually transmitted infections chlamydia and gonorrhea. Symptoms include abdominal pain and abnormal discharge. Treatment involves antibiotics to prevent complications like infertility or ectopic pregnancy. Prevention focuses on screening and treatment of chlamydia, as well as testing and treating partners of those diagnosed with PID.
Presentation notes about PID for medical students, undergraduate doctors and other health allied courses. It was prepared by medical doctor at Free Medicine.
This document provides information about sexually transmitted diseases (STDs). It discusses several common STDs including chlamydia, gonorrhea, genital herpes, and syphilis. For each STD, it describes the causative agent, transmission, clinical manifestations, diagnosis, treatment, and nursing implications. The highest rates of STDs are among adolescents and young adults. Prevention emphasizes limiting sexual partners, condom use, and health education.
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract including the uterus, fallopian tubes, and ovaries. It is usually caused by ascending infection with bacteria such as Neisseria gonorrhoeae and Chlamydia trachomatis that spread from the vagina or cervix. Risk factors include multiple sex partners and prior STDs. Symptoms can include lower abdominal pain and abnormal vaginal discharge. Diagnosis is based on clinical criteria and treatment involves antibiotics targeting the common causative agents. Complications may include infertility, ectopic pregnancy, and chronic pelvic pain if left untreated. Prevention focuses on screening and treatment of STDs, partner management, and education.
Induction of labour is artificially stimulating the onset of labour, prior to the spontaneous onset. This is one of the commonest interventions in obstetrics. 65% of women will give birth without further interventions when induced. However, 15% will have instrument deliveries and 20% will end up with caesarean sections.
One fifth of women will not deliver by 41 weeks of gestation. These women need induction of labour to reduce caesarean section rates. Early induction of labour is needed for certain maternal and fetal indications. However, unnecessary inductions will lead to undesired complications and added health costs. 70% of women do not like induction of labour.
Induction of labour can be prevented by accurate dating and membrane sweeping starting from 39 weeks. There are pharmacological and non-pharmacological methods of induction. Usage depends on presence or absence of a scarred uterus, Bishop’s score, parity, obstetrician’s, and patient’s preferences. There are many complications of induction of labour out of which commonest being uterine hyperstimulation. Induction of labour between 34-41 weeks of gestation can lead to increase caesarean section rates
Haemostasis is very important in laparoscopic surgery. Vessel sealing with energy devises play a major role in keeping the surgical field clear. Energy devices are also used for tissue sealing and transection. Despite never types of energy devises electro-surgery is still very popular in gynaecological laparoscopy. Desiccation, dissection, and coagulation are the main effects of electro-surgery that are used for various purposes. Higher thermal injury with monopolar devices lead to the invention of bipolar devices with less tissue damage. Ligasure, pk gyrus, ENSEAL are some of the more advanced bipolar devices. Ultrasonic devices have the capability of coagulation and cutting tissues. During the process it can produce significant thermal injury. Thunderbeat combines bipolar and ultrasonic energy for coagulation and cutting respectively for more precise effects. Laser devices emit a beam of photons with a high degree of spatial and temporal coherence with tissue effects depending on the time of exposure and power density. CO2, Argon, Nd: YAG, KTP-532 are different laser types with different properties. Plasma is the fourth state of matter following solid, liquid and gas. Argon neutral plasma (System 7550TM ABC, Cardioblate) can produce energy in 3 forms including light, heat and kinetic energy. Laser and plasma energy are gaining more popularity for endometriosis surgery due to its localised effects and better preservation of ovarian follicles.
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Oral
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Pelvic inflammatory disease
1. Pelvic Inflammatory
Disease - Basics
Indunil Piyadigama
54th Anuual Scientific Congress
Sri Lanka College of Obstetricians and Gynaecologists – 28th November 2021
2. PID
• Commonly used to describe
ascending pelvic infection from the
endocervix
• Involving at least the endometrium
and fallopian tubes
• A dynamic disease process involving
a variety of microorganisms
• Microorganisms that ascend from
the lower genital tract cause most
cases
• Less commonly, direct spread from
intra abdominal sepsis
• Usually associated with the bowel
• Rarely from blood-borne infection
such as tuberculosis
3. Aeitiology
• Two major groups of microorganisms associated with the disease
• Sexually transmitted infections(STIs)
• The endogenous flora of the lower genital tract
• Neisseria gonorrhea
• Chlamydia Trachomatous
• Genital mycoplasmas
• Endogenous anaerobes – Bacteroides, Prevotella, Gardnerella vaginalis,
Peptostreptococci species, Escherichia coli, Haemophilis influenzae
• Endogenous Aerobes - Streptococci
• Viral pathogens do not seem to have a role in the causation of PID
4. Swedish study 1970 to 1994
• Incidence of PID increased to a peak of 17.5 per 1000 women in the mid-
1970s
• 75% of cases in women aged 15 to 24 were associated with chlamydial or
gonococcal infection in these studies
• Subsequently PID cases decreased to less than one per 1000 women in
1990 - 1994
• This correlated with
• IUD prescription to young nulliparous women in the mid-1970s
• Paralleled the decrease nationwide in gonorrhoea after 1975
• The introduction of successful programmes to control genital chlamydial infection
• Only minor changes in PID incidence occurred in women aged 30 or above
during the same period
5. Pathophysiology
• Younger women tend to have PID with Chlamydia and Gonorrhoea
• Older women tend to have PID more with endogenous vaginal organisms.
Therefore tend to have more suppurative disease
• Only a Small proportion of women with chlamydial or gonococcal cervicitis
develops upper genital tract infections
• No clear variation in virulence identified between different serotypes of these
pathogens
• Intermittent ascent of microorganisms may be a physiological occurrence
• Spermatozoa have been demonstrated to carry bacteria in to the pelvic cavity
• Dynamic process
• Begins as a mono microbial process initiated by primary pathogens such as N.gonorrhoeae
and C.trachomatis
• Progresses to become polymicrobial through the recruitment of endogenous bacteria
6. Pathophysiology continued
• Irreversible tubal deciliation
• Intraluminal adhesions and tubal occlusion can develop within days of the
onset of inflammation
• Direct effects of the pathogen
• The immune response (delayed type hypersensitivity)
• Delay in seeking care for more than a few days after the onset of pain is
associated with
• Significant increase in infertility
• Ectopic pregnancy
• Formation of a tubo-ovarian abscess is a late stage in the process of PID
when anaerobic bacteria predominate
7. Risk factors
• Chlamydial or gonococcal infection in the lower genital tract
• Demographic risk markers associated with sexual behaviour
• Young age (15-24)
• Being single, separated or divorced
• Low socioeconomic status
• Bacterial vaginosis
• Surgical instrumentation through the uterine cervix
• Termination of pregnancy
• IUD insertion – First six weeks after insertion. Risk decreases over the post insertion period
• Uterine evacuation
• Hysterosalpingography
• Vaginal douching
8. Protective
• Hormonal contraception
• Altering the consistency of the cervical mucous plug
• Influencing the immune response to infection
• Barrier methods
9. Clinical features of PID
• Can be symptomatic or asymptomatic
• The severity of tubal pathology in PID seems unrelated to the presence or
absence of a symptomatic episode
• Cardinal symptom is bilateral lower abdominal pain
• Cardinal clinical signs are bilateral adnexal tenderness and cervical excitation
• Abnormal vaginal discharge (50 - 60%)
• Irregular vaginal bleeding (35%)
• Dysuria (20%)
• Deep dyspareunia
• Systemic manifestations, including nausea, vomiting, malaise and temperature
• Considered severe PID if Fever > 380C, tubo-ovarian abscess formation, peritonitis
10. Fitz Hugh Curtis syndrome
• Cause right upper quadrant pain and right
hypochondrial tenderness
• Inflammation of the liver capsule with fibrinous
adhesions between the liver capsule and the
parietal peritoneum under the ribs is seen at
laparoscopy
• Up to 15% of patients with acute PID
• Due to perihepatitis from intraabdominal spread of
N. gonorrhoeae and C. trachomatis
11. Investigations
• Pregnancy test
• HIV testing
• Lower genital tract swabs, Endocervical swabs
• Positive gonorrhea or chlamydia in lower genital tract swabs supports
diagnosis
• Endocervical or vaginal pus cells
• Presence is nonspecific
• Only 20% positive predictive value for diagnosing PID
• But if pus cells negative highly unlikely to be having PID (95% NPV)
• ESR and CRP increase supports the diagnosis. But not specific
12. Laparoscopy
• Regarded as the definitive
investigation to diagnose PID
• The sensitivity of laparoscopy in
identifying salpingitis has been
reported as being as low as 50% when
compared with fimbrial histological
criteria
• Highlights the poor specificity of
clinical criteria
• Less than 10% of laparoscopically
confirmed salpingitis is unilateral
13. Management
• There are no definitive diagnostic criteria
• But PID can lead to severe consequences
• Therefore, low threshold should be maintained for treatment
• Adnexal tenderness in the absence of other diagnoses should be
regarded as the minimal criterion for the diagnosis of PID
• Incorrectly telling a patient that she has PID when she does not can
have psychological and social consequences
14. The aims of treatment
Alleviate the pain
and systemic
symptoms
associated with
infection
01
Achieve
microbiological
cure
02
Preserve fallopian
tube structure and
function
03
Prevent the spread
of infection to
others
04
16. Gonorrhoea
• 50% women are asymptomatic
• Vaginal discharge
• Pain
• Urethritis
• These symptoms are found in
descending order of frequency
17. Diagnosis
• Nucleic acid amplification test (NAAT)
• Vaginal or cervical swabs can be used – Sensitivity 96%
• Urine is not sensitive in women
• Confirmation is with culture in Thyar Martin agar
• Endocervical or urethral swabs are used for culture
• Refrigerate the sample if delay in transport
• PCR can also be done on endocervical swabs
18. Management
Antibiotics
• IM Ceftriaxone 500mg single dose
or Oral Cefixime 400mg single dose
• IM Spectinomycin 2g single dose
Follow up
• Test of cure is recommended after
2 weeks due to emerging antibiotic
resistance
19. Chlamydia
• Clinical features
• 80% of women are asymptomatic
• Diagnosis
• NAAT
• Sensitivity 95% with vulvovaginal
swabs
• Urine less sensitive
• SL – PCR from endocervical swabs
or urine
20. Management
• Oral Azithromycin 1g single dose
• Oral Doxycycline 100mg bd for 7 days
• Oral Erythromycin 500mg qds for 7 days
or Oral Erythromycin 500mg bd for 14
days
Antibiotics
• Not needed in Chlamydia
• If done for any reason recommended
after 6 weeks of treatment
Test of cure
21. Oral antibiotics for
PID
1. IM Ceftriaxone 500mg stat followed by Oral Doxycycline
100mg bd + Oral Metronidazole 400mg bd for 14 days
2. Oral Ofloxacin 400mg bd + Oral Metronidazole 400mg bd for
14 days
• Alternatively Levofloxacin 500mg daily can be used as an
alternative to Ofloxacin
• Regimes with metronidazole are useful in more symptomatic
where anaerobic coverage is needed
3. IM Ceftriaxone 500mg followed by Azithromycin 1g/week for 2
weeks
• This regime is preferred if suspecting gonorrhea as the
causative organism, since gonorrhea is getting resistant to
quinolones and cephalosporines
22. IV antibiotics for PID
1. IV Ceftriaxone 2g daily + IV Doxycycline 100mg bd
2. IV Clindamycin 900mg tds + IV Gentamycin 2mg/kg
dose followed by 1.5mg/kg tds
• IV antibiotics are preferred for severe PID
• Continue as in patient treatment till 24 hours of patient
becoming well
• Convert to oral antibiotics for 14 days
• HIV infected individuals have more severe symptoms.
But responds well to antibiotics
23. Surgical management
• In the minority of cases that do not
respond to conservative management
• Laparoscopy or laparotomy for
adhesiolysis and draining pelvic abscess
• Perihepatic adhesiolysis
• Ultrasound guided abscess drainage is
also equally effective
24. Treatment of the male partner
• Oral Azithromycin 1g stat
• Avoid intercourse until both partners have completed the treatment
course
• Barrier methods of contraception prevent PID
• Need to screen sexual contacts to prevent reinfection
25. Others
• Remove IUD and additional contraceptives for the given period
• IUD removal is usually recommended if the PID is severe enough to
warrant hospitalisation
• 20% of patients with PID have recurrent attacks and an IUD might not
be the most appropriate contraceptive method
26. Follow up
• 72 hours – for clinical improvement
• 2-4 weeks
• To check for clinical response
• Compliance
• Sexual contact screening and treatment
• Repeat of pregnancy test
• Repeat testing for Chlamydia and gonorrhea at 6 weeks
• If continuing to have symptoms
• Poor compliance
• Sexual contacts positive for STI
• Positive pregnancy test
27. Complications
• Repeated pelvic infections lead to exponential increase in
complications
• Tubal factor infertility
• The risk of TFI after one episode of PID is about 8%
• Increasing to about 20% after two episodes
• To about 40% after three episodes or more
• Chronic pelvic pain has been reported in15-20%
• the first pregnancy after PID was ectopic in 9.1% of women compared
with 1.4% in the control women
28. Prevention
Primary prevention - measures to prevent exposure to infection
• Use of barrier methods
• Delaying the onset of sexual activity and exploring attitudes and values related to intercourse
• Most women with lower genital tract chlamydial or gonococcal infection are symptom free. Therefore
screening programs
• Treating cervical infections prior to uterine instrumentation
• RCOG - Patients undergoing termination of pregnancy should
• Either receive antibiotic prophylaxis or
• Screened for lower genital tract organisms with treatment of positive cases
• Non-pregnant patients under the age of 35 under going uterine instrumentation (for example IUD insertion)
should similarly be screened prior to the procedure or, failing that, should receive prophylactic antibiotics.
Secondary prevention - the detection and treatment of lower genital tract infection to prevent ascent to the
upper genital tract
Tertiary prevention - Early effective treatment to limit tubal damage
29. Conclusions
• PID is mainly a disease of the younger women
• PID can have a huge impact on future fertility
• STIs and endogenous organisms are the cuasative agents
• Difficult to diagnose since there is no specific criteria
• Important to have a low threshold for treatment
• There are many steps in preventing PID and its complications
30. References
• Sample collection manual for STI and HIV testing. National reference laboratory for STI and HIV. National STD/ AIDS control
programme in Sri Lanka
• Evidence based medicine
• Haitham Hamoda; Chris Bignell (2002). Pelvic infections. , 12(4), 0–190.doi:10.1054/cuog.2001.0258
• Bevan CD, Johal BJ, Mumtaz G, Ridgeway GL, Siddle NC. Clinical, la- paroscopic and microbiological ¢ndings in acute salpingitis:
report onaUnitedKingdomcohort.BrJObstetGynaecol1995;102:407^ 414.
• Westr ̨mLetal.Pelvicin£ammatorydiseaseandinfertility.Acohort studyof1844womenwithlaparoscopicallyveri¢eddiseaseand 657
control women with normal laparoscopic ¢ndings. Sex Trans Dis1992; 185:185^192.
• Ross JDC. European guideline for the management of pelvic in£amma- tory disease and perihepatitis. Int J STD AIDS 2001;
12(Suppl. 3): 84^87.
• MannS,SmithJR.Cervicitisandpelvicin£ammatorydisease.TheYear- book of Obstetrics and Gynaecology, Vol. 6. London: RCOG Press,
1998.
• Munday PE. Pelvic in£ammatory disease F an evidenced-based ap- proach to diagnosis. J Infect 2000; 40: 31^ 41.
• Eschenbach DA, Wolner-Hanssen P, Hawes SE, Pavletic A, Paavonen J, HolmesK.Acutepelvicin£ammatorydisease:associationsofclin-
icalandlaboratory¢ndingswithlaparoscopic¢ndings.ObstetGy- naecol1997; 89:184^192.
• BevanC.Pelvicin£ammatorydisease.RCOG,PersonalAssessmentin Continuing Education,1998.
Less commonly, infection of the upper genital tract may arise from direct spread from an area of intra abdominal sepsis, usually associated with the bowel, or rarely from blood-borne infection such as tuberculosis