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.
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Secretions produced by the glands of vaginal wall and cervix that drain from the vaginal opening.
Vaginal discharge is a common presentation of women to the STI clinic
Can be physiological or pathological
Related with some common STIs
Infections of the Genital Tract - Part IHelen Madamba
Lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of infections affecting the vulva, such as infections of the Bartholin's gland, ectoparasites and infections presenting as vulvar ulcers. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
PowerPoint presentation of emesis in pregnancy given at resident presentation, obstetrics and gynecology directorate, Komfo Anokye Teaching Hospital
risk factors, symptoms, management of severe vomiting with dehydration and weight loss in pregnancy
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
Infections of the Genital Tract - Part IHelen Madamba
Lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of infections affecting the vulva, such as infections of the Bartholin's gland, ectoparasites and infections presenting as vulvar ulcers. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
PowerPoint presentation of emesis in pregnancy given at resident presentation, obstetrics and gynecology directorate, Komfo Anokye Teaching Hospital
risk factors, symptoms, management of severe vomiting with dehydration and weight loss in pregnancy
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
Infections of the Genital Tract - Part IIIHelen Madamba
Heavily lifted from the CDC STD Treatment Guidelines 2015, this is a discussion of cervicitis, pelvic inflammatory disease and prevention of sexually transmitted infections in victims of sexual assault. This was a lecture delivered to an audience of second year medical students at the Cebu Doctors University College of Medicine.
An alternative way at looking at pregnancy complicated by diabetes. A guide for the student in understanding this problem and the important points to be included in a clinical assessment.
PID and its newer concepts.This presentation is done after grouping information from a variety of textbooks,journals and of course our professors.will definitely enlighten you
pelvic inflammatory disease is the infectious disease in the female upper genital organ and its causes discomfort to the patient and knowledge of this ppt can help the patients and nurses to know the disease process well and can apply this knowledge into their clinical practices
Chronic pelvic pain can be defined as intermittent or constant pain in the lower abdomen or pelvis of a woman of at least 6 months in duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy.
An Obstetrics and gynecology presentation: A 20 years old single female undergraduate presents to the emergency unit with fever, lower abdominal pain and abnormal vaginal discharge of 5 days duration. Discuss her management
Acute pelvic inflammatory disease by dr alka mukherjee dr apurva mukherjeealka mukherjee
Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.
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The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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http://sandymillin.wordpress.com/iateflwebinar2024
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Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
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Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
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June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
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2. PID: A NEGLECTED ISSUE
• Low disease awareness
• Sub-optimal management
• 50% named correct antibiotic regimen
• < 25% examined the sexual partners
3. OBJECTIVES
• What is Pelvic Inflammatory Disease?
• Why is it important to treat timely?
• Causative factors and transmission?
• How does the patient present?
• Treatment Plan?
- Drug therapies
- Surgical procedures
- Follow up
4. PELVIC INFLAMMATORY DISEASE
• Clinical syndrome associated with ascending
spread of microorganisms from the vagina or
cervix to the endometrium, fallopian tubes,
ovaries, and contiguous structures.
• Comprises a spectrum of inflammatory disorders
including any combination of endometritis,
salpingitis, tubo-ovarian abscess, and pelvic
peritonitis.
9. INCIDENCE
• The exact prevalence is hard to ascertain
as many cases may go undetected, but is
thought to be in the region of 1-3% of
sexually active young women.
10. Transmission
•
• Sexual transmission
via the vagina & cervix
• Gynecological
surgical procedures
• Child birth/ Abortion
• A foreign body inside
uterus (IUCD)
11. Transmission
•
• Contamination from
other inflamed structures
in abdominal cavity
(appendix, gallbladder)
• Blood-borne transmission
(pelvic TB)
35. SYNDROMIC DIAGNOSIS OF PID
MINIMUM CRITERIA FOR DIAGNOSIS
(CDC 2002)
• Lower abdominal tenderness on palpation
• Bilateral adnexal tenderness
• Cervical motion tenderness
No other established cause
Negative pregnancy test
36. ADDITIONAL CRITERIA (CDC 2002)
• Oral temperature > 38.3°C (101°F)
• Abnormal cervical / vaginal discharge
• Elevated ESR
• Elevated C-reactive protein
• WBCs on saline micro. of vaginal sec.
• Lab. documentation of cervical infection
with N. gonorrhea/ C. trachomatis
38. MANAGEMENT ISSUES
•
• Inpatient vs. outpatient management ?
• Broad-spectrum antibiotic therapy
without microbiological findings
vs.
Antibiotic treatment adapted to the
microbiological agent identified ?
• Oral vs. Parenteral therapy?
• Duration of the treatment ?
• Associated treatment ?
• Prevention of re-infection ?
39. GENERAL PID CONSIDERATIONS
Regimens must provide coverage of N. gonorrhea, C.
trachomatis, anaerobes, Gram-negative bacteria, and
streptococci
Treatment should be instituted as early as possible to
prevent long term squeal
40. CRITERIA FOR HOSPITALIZATION
• Inability to exclude surgical emergencies
• Pregnancy
• Non-response to oral therapy
• Inability to tolerate an outpatient oral
regimen
• Severe illness, nausea and vomiting, high
fever or tubo-ovarian abscess
• HIV infection with low CD4 count
41. ANTIBIOTIC THERAPY
Gonorrhea : Cephalosporin's, Quinolones
Chlamydia: Doxycycline, Erythromycin &
Quinolones (Not to cephalosporin's)
Anaerobic organisms: Flagyl, Clindamycin
and in some cases to Doxycycline.
Beta hemolytic streptococcus and E. Coli
Penicillin derivatives, Tetracycline's, and
Cephalosporin's., E. Coli is most often treated
with the penicillin's or gentamicin.
42. ORAL REGIMENS
• CDC-recommended oral regimen A
• Ceftriaxone 250 mg IM in a single dose, PLUS
• Doxycycline 100 mg orally 2 times a day for 14 days
With or Without
• Metronidazole 500 mg orally 2 times a day for 14 days
• CDC-recommended oral regimen B
• Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally in a
single dose, PLUS
• Doxycycline 100 mg orally 2 times a day for 14 days
With or Without
• Metronidazole 500 mg orally 2 times a day for 14 days
• CDC-recommended oral regimen C
• Other parenteral third-generation cephalosporin (e.g.,
Ceftizoxime, Cefotaxime), PLUS
• Doxycycline 100 mg orally 2 times a day for 14 days
With or Without
• Metronidazole 500 mg orally 2 times a day for 14 days
43. FOLLOW-UP
• Patients should demonstrate substantial improvement
within 72 hours.
• Patients who do not improve usually require
hospitalization, additional diagnostic tests, and
surgical intervention.
• Some experts recommend re-screening for C.
trachomatis and N. gonorrhea 4-6 weeks after
completion of therapy in women with documented
infection due to these pathogens.
• All women diagnosed clinical acute PID should be
offered HIV testing.
44. PARENTERAL REGIMENS
• CDC-recommended parenteral regimen A
• Cefotetan 2 g IV every 12 hours, OR
• Cefoxitin 2 g IV every 6 hours, PLUS
• Doxycycline 100 mg orally or IV every 12 hours
• CDC-recommended parenteral regimen B
• Clindamycin 900 mg IV every 8 hours, PLUS
• Gentamicin loading dose IV or IM (2 mg/kg),
followed by maintenance dose (1.5 mg/kg) every 8
hours. Single daily gentamicin dosing may be
substituted.
45. ALTERNATIVE PARENTERAL REGIMEN
• Ampicillin/Sulbactam 3 g IV every 6 hours, PLUS
• Doxycycline 100 mg orally or IV every 12 hours.
• It is important to continue either regimen A or B
• or alternative regimens for at least 24 hours after
substantial clinical improvement occurs and also
to complete a total of 14 days therapy with:
• Doxycycline 100mg orally twice a day OR
• Clindamycin 450mg orally four times a day.
46. CDC RECOMMENDATIONS
• No efficacy data compare parenteral
with oral regimens
• Clinical experience should guide
decisions reg. transition to oral therapy
• Until regimens that do not adequately
cover anaerobes have been demonstrated to
prevent squeal as successfully as
regimens active
against these microbes, anaerobic
coverage should be provided
47. When should treatment be stopped ?
• Parenteral changed to oral therapy after
72 hrs., if substantial clinical improvement
• Continue Oral therapy until clinical &
biological signs (leukocytosis, ESR, CRP)
disappear or for at least 14 days
• If no improvement, additional diagnostic
tests/ surgical intervention for pelvic mass/
abscess rupture
48. Associated treatment
Rest at the hospital or at home
Sexual abstinence until cure is achieved
Anti-inflammatory treatment
Dexamethasone 3 tablets of 0.5 mg a day
or Non steroidal anti-inflammatory drugs
Oestro-progestatives: contraceptive effect
+ protection of the ovaries against a
peritoneal inflammatory reaction +
cervical mucus induced by OP has
preventive effect against re-infection.
49. Special Situations
Pregnancy
- Augmentin or Erythromycin
- Hospitalization
Concomitant HIV infection
- Hospitalization and i.v. antimicrobials
- More likely to have pelvic abscesses
- Respond more slowly to antimicrobials
- Require changes of antibiotics more often
- Concomitant Candida and HPV infections
50. Surgery in PID
Indications
Acute PID
- Ruptured abscess
- Failed response to medical treatment
- Uncertain diagnosis
Chronic PID
- Severe, progressive pelvic pain
- Repeated exacerbations of PID
- Bilateral abscesses / > 8 cm. diameter
- Bilateral ureteral obstruction
51. SURGERY IN PID
• Timing of Surgery
- No improvement within 24-72 hours
- Quiescent (2-3 months after acute stage)
• Type of Surgery
- Colpotomy
- Percutaneous drainage/ aspiration
- Exploratory Laparotomy
• Extent of Surgery
- Conservation if fertility desired
- U/L or B/L S.Ophrectomy ē/ š subtotal/ TAH
- Drainage of abscess at laparotomy
- Identification of ureters
54. FOLLOW UP
● Re-screening for Chlamydia & Gonorrhea
● Patient counseling:
- Risk of re- infection and sequel.
- Sexual counseling
- Avoid douching
55. Management of sex partners
• Examination and treatment
if they had sexual contact
with patients during the 60 days
preceding the onset of symptoms
in the patients.
• Empirical treatment with regimens
effective against C. trachomatis
and N. gonorrhea
56. OPPORTUNITIES FOR CONTROL
STD PID Infertility
STD
Influenced by Interaction of
following Environments
Genital Microbial Environment
Individual Behavioral Environment
Socio-geographic Environment
57. PREVENTION
• PRIMARY PRVENTION
• To reduce the incidence of PID, screen
and treat for chlamydia.
• Annual chlamydia screening is
recommended for:
• Sexually active women 25 and under
• Sexually active women >25 at high risk
• Screen pregnant women in the 1st
trimester.
58. PARTNER MANAGEMENT
• Male sex partners of women with PID
should be examined and treated if they
had sexual contact with the patient
during the 60 days preceding the
patient’s onset of symptoms.
59. PARTNER MANAGEMENT (CONTINUED)
• Male partners of women who have PID
caused by C. trachomatis or N. gonorrhea
are often asymptomatic.
• Sex partners should be treated empirically
with regimens effective against both C.
trachomatis and N. gonorrhea, regardless of
the apparent etiology of PID or pathogens
isolated from the infected woman.
60. REPORTING
• Report cases of PID to the local STD
program in states where reporting is
mandated.
• Gonorrhea and chlamydia are
reportable in all states.
61. PATIENT COUNSELING AND EDUCATION
• Nature of the infection
• Transmission
• Risk reduction
• Assess patient's behavior-change
potential
• Discuss prevention strategies
• Develop individualized risk-reduction
plans
62. .
Secondary Prevention:
• - Screening for infections in high- risk.
- Rapid diagnosis and effective treatment
of STD and lower urinary tract infections.
Tertiary Prevention:
- Early intervention & complete treatment.
63. CONCLUSION
● PID in women - “Silent epidemic”
● Can have serious consequences.
● Be aware of limitations of clinical diagnosis.
● Adequate analgesia and antibiotics.
● Proper follow up is essential.
● Treatment of male partner
● Educational campaigns for young women
and health professionals.
● Prevention by appropriate screening for STD
and promotion of condom usage.
64. SUMMARY
● PID in women - “Silent epidemic”
● Can have serious consequences.
● Be aware of limitations of clinical diagnosis.
● Adequate analgesia and antibiotics.
● Proper follow up is essential.
● Treatment of male partner
● Educational campaigns for young women
and health professionals.
● Prevention by appropriate screening for STD
and promotion of condom usage.