Download FEMALE GENITAL INFLAMMATORY DISEASES

FEMALE GENITAL
INFLAMMATORY
DISEASE
By doc. O.Y. Stelmakh
Pelvic Inflammatory
Disease
• A nonspecific term that most
commonly refers to inflammation
caused by infection in the upper
genital tract;
• Often used synonymously with
the term acute salpingitis.
Infectious agents - STDs
PID – Ascending infection
General classification of pelvic infections
by frequency of occurrence:
PID
• Endometritis
• Pelvic cellulitis
• Oophoritis
• tubo-ovarian abscess
• Pelvic peritonitis
Clinical forms
Complicated
Endometritis
Acute purulent salpingitis
pelvioperitonitis
Uncomplicated
Purulent tubo-ovarian abscess
Other inflamed tumors of uterus
appendages
Clinical features
• Acute
• Subacute
• Reccurent
• Chronic
Incidence
• Acute pelvic inflammatory disease occurs in 1%
to 2% of all young, sexually active women.
• It is the most common serious infection of
women aged 16 to 25.
• Approximately 85% of infections are
spontaneous in sexually active females.
• The other 15% of infections develop following
procedures that break the cervical mucus
barrier, allowing the vaginal flora the opportunity
to colonize the upper genital tract.
The most common etiologic
agents in PID
• These organisms initially cause lower genital tract
infections and then spread into the upper genital
tract via the endometrium.
• Many cases - polymicrobial in etiology. Pure
gonococcal or chlamydial PID is possible.
• The relative frequency of the various agents
depends somewhat on
– the population tested,
– the site cultured (i.e., cervix, endometrium, or
Fallopian tubes),
– the sensitivity of the diagnostic tests performed.
The most common etiologic
agents in STD
•
•
•
•
•
•
•
•
•
•
•
There are at least 20 different STIs. They can be caused by viruses,
bacteria, and protozoa. Some of the most common STIs in the U.S.
are:
Chlamydia.
Genital herpes.
Genital warts or human papillomavirus (HPV). Certain high-risk types of
HPV can cause cervical cancer in women.
Gonorrhea.
Hepatitis B.
Syphilis.
Trichomoniasis.
Human immunodeficiency virus (HIV), which causes AIDS. Having
other STIs, such as genital herpes, can increase your risk of HIV.
Other infections that may be sexually transmitted. These include
hepatitis A, cytomegalovirus, molluscum contagiosum, Mycoplasma
genitalium, hepatitis C, and possibly bacterial vaginosis.
Scabies and pubic lice, which can be spread by sexual contact.
Provocative agents
•
•
•
•
•
•
Menses
Intercourse
Abortion; miscarriage
Curettage of uterine cavity
Hysterosalpingography
In vitro fertilization
Intra-abdominal spread of gonorrhea
and other pathogenic bacteria
These infections are represented by
•endometritis,
•adnexal infection,
•peritonitis.
Lymphatic spread of bacterial
infection
Typified by postpartum, postabortal, and some
IUD-related infections, results in extraperitoneal
parametrial cellulitis.
Hematogenous spread of bacterial
infection
In rare instances, certain diseases (eg, tuberculosis)
may gain access to pelvic structures by
hematogenous routes
Infectious agents - STDs
PID – Ascending infection
PID: History and Examination
Symptoms suggestive of PID include 3 or more
signs:
• Abdominal pain (usually bilateral and in the
lower quadrants)
• Onset of pain in association with menses,
• Menometrorrhagia,
• Vaginal discharge (purulent),
• Dyspareunia,
• Dysuria,
• Fever, and/or chills,
• Nausea or vomiting.
PID: History and Examination
• Painful palpation of the uterus
and appendages during
bimanual examination
• Blood test – WBC, ESR
PID: History and Examination
• Laparoscopy should be
st
performed at the 1 day
inpatient treatment after lab
examination in parallel with
antibiotic therapy
Laparoscopic findings – Acute PID
N
Pyosalpinx
Pelvic inflammatory disease (PID) is a serious complication
of untreated STDs, especially chlamydia and gonorrhea. It
happens when bacteria spread to infect the uterus and
other female reproductive organs.
Trichomoniasis is caused by a parasite that spreads during
sexual contact. It can be cured with prescription drugs.
Diagnosis
Culdocentesis generally is productive
of “reaction fluid” (cloudy peritoneal
fluid) which, when stained, reveals
leukocytes with or without gonococci or
other organisms.
Ultrasound: incomplete septation of the
tubal wall (“cogwheel sign”) is a marker
for acute disease, and a thin wall
(“beaded string”) indicates chronic
disease.
U: Uterus
U
M
F
C: Cervix
F: Fallopian Tube
O
O: Normal Ovary
M: Inflamed TuboOvarian Mass
C
Note the hemorrhagic, edematous fallopian tubes, so
much so that the architecture of the right tube and ovary
is obscured. The surface of the tubo-ovarian mass is not
only red but also somewhat shaggy.
Look at how profoundly edematous all aspects of this
fallopian tube are. We are going to focus on the mucosal
folds, but the inflammatory features are present
throughout this specimen.
Complications of Acute
Salpingitis:
Pyosalpinx
In which one or both fallopian tubes are
filled with pus, may also be present.
The fluid may be sterile, but WBCs
predominate in it.
Chlamydia is a common STD that can lead to infertility if left
untreated. It clears up quickly with antibiotics. But it often
goes unnoticed because symptoms are vague or absent.
Chlamydia can also infect the rectum and throat.
Symptoms: Common symptoms are burning during urination
and discharge, but often there are no early symptoms.
Later, the infection may cause skin rashes or spread to the
joints and blood
Differential Diagnosis
• Acute salpingitis must be differentiated
from acute appendicitis, ectopic
pregnancy, ruptured corpus luteum cyst
with hemorrhage, diverticulitis, infected
septic abortion, torsion of an adnexal
mass, degeneration of a leiomyoma,
endometriosis, acute urinary tract
infection, regional enteritis, and ulcerative
colitis.
Partners of patients
with
.
infection also need to be
treated
Recurrent or Chronic
Pelvic Infection
• Recurrent pelvic inflammatory disease
begins as does primary disease, but
preexisting tubal tissue damage may result
in more severe infection.
• Chronic pelvic infection implies the
presence of tissue changes in the
parametria, tubes, and ovaries.
Pelvic inflammatory disease (PID) is a serious complication
of untreated STDs, especially chlamydia and gonorrhea. It
happens when bacteria spread to infect the uterus and
other female reproductive organs.
Complications
• Unruptured TOA may be complicated by
rupture with sepsis, reinfection at a later
date, bowel obstruction, infertility, and
ectopic pregnancy.
• Ruptured TOA is a surgical emergency
and is frequently complicated by septic
shock, intra-abdominal abscess (eg,
subphrenic abscess), and septic emboli
with renal, lung, or brain abscess.
Primary prevention
• teaching adolescents safe sex
practices
• promoting use of condoms and
chemical barrier methods.
Secondary prevention
Universal screening of women
at high risk for chlamydia and
gonorrhea;
Screening for active cervicitis;
Increasing use of sensitive
tests to diagnose lower genital
infection;
Treatment of sexual partners;
Education to prevent recurrent
infection.
There are three major
sequelae of PID:
ectopic pregnancies,
chronic pain,
infertility