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12 Cards in this Set
- Front
- Back
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types of upper genital tract infections
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endometritis
parametritis salpingitis oophoritis |
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risk factors
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- multiple sex partners
- prior episode of PID - use of IUCDs (Actinomyces) - NG/CT cervicitis or partner - instrumentation of uterine cavity (endometrial sampling, IUCD insertion, uterine sounding, intrauterine examination, endometrial resection) - post-abortion/partum (products of contraception) - local spread (acute appendicitis) - hematogenous (eg. tuberculous salpingitis) (protected by OCP use b/c of thinner mucus) |
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DDx
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acute appendicitis
endometriosis adnexal torsion pelvic adhesions corpus luteal bleeding mesenteric adenitis/ischemic bowel ectopic pregnancy |
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Si and Sx
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lower abdo pain/tenderness
adnexal tenderness cervical motion tenderness (chandelier sign) fever leucocytosis purulent cervical discharge pelvic mass (clinically/US) ?TOA (tubo-ovarian abscess) |
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bugs that cause PID
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NG
CT aerobes: eg. E. coli, Strep. anaerobes: eg. Bacteroides |
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Ix
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- FBE (increase WCC, left shift)
- CRP (increased) - beta-hCG (to exclude preg) - cervical swab MCS - endocervical swab +/- urine (CT) - pelvis US may reveal free fluid, TOA, mass, or retained POC |
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how to get Dx
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If Dx unclear or pt severely unwell, treat as per PID!!!
Investigate with diagnostic laparoscopy. Look for swollen erythematous tubes, purulent pelvic exudate. Take fluid for culture. Can exclude ovarian cyst, endometriosis, etc. |
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Mx
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R/o pregnancy
Err on side of over-Dx Treat early w/broad-spec Abx. Re-assess in 48-72h if outpt. ID and treat sexual partners if NG/CT. Screen for co-existing lower genital tract inf'n. Encourage barrier contraception/spermicide. Remove IUCD. ?D+C if post-partum. Caution with curettage --> Asherman's syndrome. |
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long term consequences
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- recurrent bouts of PID
- chronic pelvic pain/dyspareunia - infertility (10% after 1st ep) - tubal ectopic - pelvic abscess that may require surgical drainage, laparotomy, aggressive IV Abx - Fitz-Hugh-Curtis syndrome |
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What is Fitz-Hugh-Curtis syndrome?
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RUQ pain and peri-hepatitis assoc'd with NG/CT PID.
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Rx if sexually acquired
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mild/moderate:
- doxycycline 100mg PO 12-hrly for 2wks + - metronidazole 400mg PO 12-hrly for 1-2wks - add ceftriaxone 250mg IM (one-dose) if NG suspected or azithromycin if compliance an issue severe: - metronidazole 500mg IV hourly + - doxycycline 100mg PO 12-hrly + - ceftriaxone 1g IV 8-hrly If preg or breast-feeding, use macrolide instead of doxycycline. |
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Rx if not sexually acquired
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mild/mod:
Augmentin + doxycycline severe: - metronidazole 500mg IV hourly + - doxycycline 100mg PO 12-hrly + - ceftriaxone 1g IV 8-hrly If preg or breast-feeding, use macrolide instead of doxycycline. + admit and ?curettage. |
