FEMALE GENITAL INFLAMMATORY DISEASE

1. FEMALE GENITAL INFLAMMATORY DISEASE By doc. O.Y. Stelmakh

2. 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.

3. Infectious agents - STDs PID – Ascending infection

4. General classification of pelvic infections by frequency of occurrence:

5. PID • Endometritis • Pelvic cellulitis • Oophoritis • tubo-ovarian abscess • Pelvic peritonitis

6. Clinical forms • Complicated • Endometritis • Acute purulent salpingitis • pelvioperitonitis • Uncomplicated • Purulent tubo-ovarian abscess • Other inflamed tumors of uterus appendages

7. Clinical features • Acute • Subacute • Reccurent • Chronic

8. 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.

9. 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.

10. The most common etiologic agents inSTD • 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.

11. Provocative agents • Menses • Intercourse • Abortion; miscarriage • Curettage of uterine cavity • Hysterosalpingography • In vitro fertilization

12. Intra-abdominal spread of gonorrhea and other pathogenic bacteria • These infections are represented by • endometritis, • adnexal infection, • peritonitis.

13. Lymphatic spread of bacterial infection Typified by postpartum, postabortal, and some IUD-related infections, results in extraperitoneal parametrial cellulitis.

14. Hematogenous spread of bacterial infection In rare instances, certain diseases (eg, tuberculosis) may gain access to pelvic structures by hematogenous routes

15. Infectious agents - STDs PID – Ascending infection

16. 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.

17. PID: History and Examination • Painful palpation of the uterus and appendages during bimanual examination • Blood test – WBC, ESR

18. PID: History and Examination • Laparoscopy should be performed at the 1st day inpatient treatment after lab examination in parallel with antibiotic therapy

19. Laparoscopic findings – Acute PID N Pyosalpinx

22. 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.

23. Trichomoniasis is caused by a parasite that spreads during sexual contact. It can be cured with prescription drugs.

24. 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.

25. F U M O C U: Uterus C: Cervix F: Fallopian Tube O: Normal Ovary M: Inflamed Tubo- Ovarian Mass 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.

26. 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.

27. 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.

28. 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.

29. 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

30. 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.

31. Partners of patients with infection also need to be treated • .

33. 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.

34. 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.

35. 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.

36. Primary prevention • teaching adolescents safe sex practices • promoting use of condoms and chemical barrier methods.

37. 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.

38. There are three major sequelae of PID: • ectopic pregnancies, • chronic pain, • infertility