Transcript Pelvic inflammatory disease

PELVIC
INFLAMMATORY
DISEASE
Nikolina Antonia Domokuš
Mentor: A. Žmegač Horvat
PELVIC INFLAMMATORY DISEASE
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infection of the uterus, fallopian tubes, and
adjacent pelvic structures that is not associated
with surgery or pregnancy
Etiology and Pathogenesis
2 stages of PID:
-acquisition of a vaginal or cervical infection
-direct ascent of micro-organisms from the
vagina and cervix
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ORGANISMS MOST COMMONLY ISOLATED :
• Neisseria gonorrhoeae and Chlamydia trachomatis
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Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma
urealyticum, herpes simplex virus-2 (HSV-2), Trichomonas
vaginalis, cytomegalovirus, Haemophilus influenzae, Streptococcus
agalactiae
Risk factors
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young age
multiple sexual partners
certain methods of contraception
previous history of chlamydia or another
sexually transmitted infection
delayed and decreased access to care
Symptoms
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lower abdominal pain
abnormal vaginal discharge
abnormal uterine bleeding
dysuria
dyspareunia
nausea
vomiting
fever
Gonococcal PID - dramatic symptoms of fever and
peritoneal irritation
Diagnosis
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physical findings: lower abdominal tenderness, adnexal
tenderness, pain on manipulation of the cervix
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laboratory studies: ESR, CRP, CBC, gonorrhea DNA probes and
culture, clamydial DNA probes and culture, testes for hepatitis and HIV
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imaging studies: transvaginal ultrasonography , CT
procedures: endometrial biopsy
laparoscopy
Complications
SCARRING INSIDE THE REPRODUCTIVE
ORGANS
CHRONIC PELVIC INFERTILITY
PAIN
SPREAD TO IN THE PERITONEUM
& FITZ-HUGH-CURTIS SYNDROME
ECTOPIC
PREGNANCY
Management
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relief of acute symptoms
eradication of current infection
minimalization of the risk of long term
consequences
antibiotics
surgery (remove or drain a tubo-ovarian
abscess)
Antibiotics
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Inpatient treatment
Outpatient treatment
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Regimen A: Administer cefoxitin 2 g IV q6h or
cefotetan 2 g IV q12h plus doxycycline 100 mg
PO/IV q12h.. Continue this regimen for 24
hours after the patient remains clinically
improved, and then start doxycycline 100 mg
PO bid for a total of 14 days. Administer
doxycycline PO when possible because of
pain associated with infusion. Bioavailability is
similar with PO and IV administrations. If tuboovarian abscess is present, use clindamycin or
metronidazole with doxycycline for more
effective anaerobic coverage.
Regimen B: Administer clindamycin 900 mg IV
q8h plus gentamicin 2 mg/kg loading dose IV
followed by a maintenance dose of 1.5 mg/kg
q8h. IV therapy may be discontinued 24 hours
after the patient improves clinically, and PO
therapy of 100 mg bid of doxycycline should
be continued for a total of 14 days. If tuboovarian abscess is present, use clindamycin or
metronidazole with doxycycline for more
effective anaerobic coverage.
Regimen A: Administer ceftriaxone 250 mg IM
once as a single dose plus doxycycline 100 mg
PO bid for 14 days, with or without
metronidazole 500 mg PO bid for 14 days.
Metronidazole can be added if there is
evidence or suspicion for vaginitis or
gynecologic instrumentation in the past 2-3
weeks.
Regimen B: Administer cefoxitin 2 g IM once
as a single dose and probenecid 1 g PO
concurrently in a single dose or other single
dose parenteral third-generation cephalosporin
(ceftizoxime or cefotaxime) plus doxycycline
100 mg PO bid for 14 days with or without
metronidazole 500 mg PO bid for 14 days.
Metronidazole can be added if there is
evidence or suspicion of vaginitis or
gynecological instrumentation in the past 2-3
weeks.
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