FEMALE GENITAL INFLAMMATORY DISEASE

1. FEMALE GENITAL INFLAMMATORY DISEASE By 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. Clinical forms

6. 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.

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

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

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

12. Infectious agents - STDs PID – Ascending infection

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

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

15. Laparoscopic findings – Acute PID N Pyosalpinx

18. 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.

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

20. 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.

21. 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.

22. 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.

23. 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.

24. 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

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

27. 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.

28. 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.

29. 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.

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

31. 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.

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