Transcript Document
Transmission • • Sexual transmission via the vagina & cervix • Gynecological surgical procedures • Child birth/ Abortion • A foreign body inside uterus (IUCD) Transmission • • Contamination from other inflamed structures in abdominal cavity (appendix, gallbladder) • Blood-borne transmission (pelvic TB) Endometritis (thickened heterogenous endometrium) Hydrosalpinx (anechoic tubular structure) Hydrosalpinx. Pyosalpinx (tubular structure with debris in adnexa Tuboovarian abscess resulting from tuberculosis Right hydrosalpinx with an occluded left fallopian tube Definitive Criteria (CDC 2002) • Endometrial biopsy with histopathology evidence of endometritis • TVS/ MRI: Thickened fluid filled tubes/ free pelvic fluid / tubo-ovarian complex • Laparoscopic abnormalities consistent with PID 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 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. 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 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 uretral obstruction 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. gonorrhoeae Prevention Primary Prevention: - Sexual counseling: practice safe sex, • limit the number of partners, avoid contact with high-risk partners, delay the onset of sexual activity until ≥ 16 years. - Barrier and Oral contraceptives reduce the risk for developing PID. 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.