Transcript PELVIC INFECTIONS

PELVIC INFECTIONS & URINARY
TRACT INFECTION
DR. AKINWUNMI L. AKINWUNTAN
MBBS (Ibadan), MHS Pop. & RH (Ibadan),
FMCOG (Nig), FWACS
OBSTETRICIAN & GYNAECOLOGIST
INTRODUCTION
• Pelvic inflammatory disease (or disorder)
(PID) is a term for inflammation of the
uterus, fallopian tubes, and/or ovaries
• It progresses to scar formation with
adhesions to nearby tissues and organs
• PID is a vague term and can refer to viral,
fungal, parasitic, though most often bacterial
infections
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Acute Salpingitis
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• STI or STD is often the cause, many
other routes are possible, including
lymphatic, postpartum (miscarriage or
abortion) or intrauterine device (IUD)
related, and hematogenous spread
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• The term "sexually transmitted
diseases" is used to denote disorders
spread principally by intimate contact
• Although this usually means sexual
intercourse, it also includes close body
contact, kissing, cunnilingus, anilingus,
fellatio, mouth–breast contact, and anal
intercourse
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EPIDEMIOLOGY
• In the United States , more than 750,000 women
are affected by PID each year, and the rate is
highest with teenagers and first time mothers
• PID causes over 100,000 women to become
infertile in the US each year
• About 2% of young women in the UK give a
history of PID if asked, and about 1 in 50
consultations with general practitioners made by
young women relate to PID
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EPIDEMIOLOGY
• RISK FACTORS:
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Young age
Multiple sex partners
Lack of condom use
Low Socio-economic class
Blacks/Caribbean origin
Genetics- HLA subtype A31 compared with HLA DQA
0501 and DQB 0402
– ??? Bacterial Vaginosis
– Indiscriminate/Improper use of antibiotics
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Organisms associated with
Pelvic inflammatory disease
Aerobic
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Neisseria gonorrhoeae
Chlamydia trachomatis
The big two
Ureaplasma urealyticum
Mycoplasma genitalium
Gardnerella vaginalis
Strep. pyogenes
Escherichia coli
Haemophilus influenzae
Mycoplasma hominis
Strep. pneumoniae
Mycobacterium tuberculosis
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Anaerobic
• Bacteroides sp.
• Peptostreptococcus sp.
• Clostridium bifermentans
• Fusobacterium sp.
Viruses
• Herpes simplex
• Echovirus
• Coxsackie
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NEISSERIA GONORRHOEAE
• Neisseria gonorrhoeae is a gram negative
diplococcus
• Can be seen on microscopy as pairs of red kidneyshaped organisms mostly sitting within
polymorphs
• Isolated in 40–60% of women with acute
salpingitis
• It initially infects the cervix but ascends the
upper genital tract in 10 -20% of untreated cases
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SYMPTOMS & SIGNS
• Most women with gonorrhea are asymptomatic
• When symptoms occur, they are localized to
the lower genitourinary tract and include:
– vaginal discharge, urinary frequency or dysuria,
and rectal discomfort
– Vulva/Vaginal itching
• The incubation period is only 3–5 days
• Bartholinitis
• Acute Pharyngitis/Tosillitis
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• Purulent vaginal discharge.
• Urinary frequency and dysuria
• Recovery of organism in selective media
• May progress to pelvic infection or
disseminated infection
• The organism may be recovered from the
urethra, cervix, anal canal, or pharynx
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• Polyathralgia
• Tenosynovitis
• Dermatitis
• Conjunctivitis
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Opthalmia Neonatorum
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Male Urethral Discharge
• Discharge coming
from the urethral
meatus
• May be frank pus,
mucopurulent, or
serous (clear)
• Occasionally
discharge will be
white in colour
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Gonococcal urethral discharge
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DIAGNOSIS
• Discharge – Urethral, Cervical, Anal,
Pharynx
• Thayer-Martins Media
• Gram Negative Diplococci in leucocytes
• ELISA
• Nucleic Acid Amplification Test
(NAATs)
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CHLAMYDIA TRACHOMATIS
• Is estimated to be the cause in about 60%
of cases of salpingitis which may lead to
PID
• Chlamydiae are obligate intracellular
microorganisms that have a cell wall similar
to that of gram-negative bacteria
• They are classified as bacteria and contain
both DNA and RNA
• Like viruses they grow intracellularly
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CLINICAL PRESENTATION
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ASYMPTOMATIC
FEVER
ABNORMAL VAGINAL DISCHARGE
LOWER ABDOMINAL PAIN
PAINFUL INTERCOURSE
IRREGULAR MENSTRUAL BLEEDING
PAINFUL MENSTRUATION
CERVICAL MOTION TENDERNESS
COMPLICATION ie Infertility
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DIAGNOSIS
• Based solely on lab test
• Cell Culture isolation: sensitivity=
70-90%
• Complement Fixation Methods
• Immunofluorescence
• DNA Probe
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Genital Ulcer Disease
Syphilis
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Chancroid
Herpes Simplex
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Genital herpes vesicles
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Typical vaginal discharge caused by
trichomoniasis
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“Strawberry cervix” due to
T. vaginalis
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PHYSICIANS’ ROLE
1. Understand the microbiology of STDs in order to appropriately
diagnose and treat patients
2. To alleviate the symptoms and prevent future sequelae
3. To prevent the transmission to others including health care
professionals
4. To do all of the above combined with patient education and
counseling
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Essential Steps In STI Care Management*
Syndrome
Assessment
Contact tracing
(diagnostic tools)
Diagnosis
Treatment
(screening tests)
Compliance
5Cs
Confidentiality
Condom use
Counseling
Risk
Assessment
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ANTIBIOTIC Rx
• CEPHALOSPORINS
– Cefuroxime
– Ceftriaxone
– Cefpodoxime eg Orelox
• MACROLIDES
– Azithromycin
• TETRACYCLINS
– Doxycycline
• FLUOROQUINOLONES
– Ciprofloxacin, Levofloxacin, Ofloxacin
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URINARY TRACT INFECTION
• A urinary tract infection (UTI) is a bacterial
inflammation in the urinary tract
• Urethritis - Urethra
• Cystitis – Bladder
• Pyelonephritis - Kidneys
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Risk factors
• Women
– Anatomy
– Sexual intercourse
– Pregnancy
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Catheterization
Bladder/Kidney stones
Immunosuppression
Stroke/Bedridden
Family history
Diabetes Mellitus
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CAUSES
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E. Coli - 80 – 85%
Klebsiella
Pseudomonas
Proteus
Enterobacter
Rarely – Viruses and Fungi
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SYMPTOMS & SIGNS
• Lower Tract
– Burning sensation on micturition
– Frequency
– Urgency
• Upper Tract
– Flank Pain
– Fever
– Haematuria/Pyuria
– Nausea and Vomiting
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– Plus symptoms of the lower tract
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SYMPTOM & SIGNS…..
• In the Elder Post-menopausal
– Incontinence
– Altered sensorium
– Fatigue
– Sepsis
– Plus earlier symptoms
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DIAGNOSIS
• HISTORY
• LAB:
– Urinalysis – Nitrites, Leucocytes, Leucocyte
Esteraces
– Urine m/c/c – WBCs, RBCs, Bacteria, Colony count
≥ 10,000/colony forming unit
Asymptomatic bacteriuria : No symptom plus
significant count
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TREATMENT
• UNCOMPLICATED
– Oral Antibiotics
– Cephalosporins eg Cefuroxime (Axacef)
– Quinolones eg Ciprofloxacin (Cyplox)
– Usually a 3-5 day course is sufficient
• PYELONEPHRITIS
– Requires prolonged medication – Parenteral
– Ceftriaxone
– Amoxicillin/Clavulanate
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