Chapter 17 Upper Female Reproductive Tract and Systemic Infections Flashcards
endometritis
infection of uterine endometrium.
endomyometritis
if infection invades into myometrium.
risk factors for pelvic inflammatory disorder include
retained products of conception, sexually transmitted infections, intrauterine foreign bodies / growths, instrumentation of intrauterine cavity.
diagnosis of endomyometritis
clinical settings with a bimanual exam revealing uterine tenderness, as well as fever and elevated WBC count.
diagnosis of chronic endometritis suspected in pts with chronic irregular bleeding, discharge, and pelvic pain. dx made in a puerperal pt with
endometrial biopsy showing plasma cells.
treatment of severe endomyometritis unrelared to pregnancy same as treatment for PID.
parenteral antibiotics.
pelvic inflammatory disease (PID) is infection of upper female genital tract including any combination of endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis. it is the most common serious complication of STIs. PID strongly associated with
infertility.
risk of ectopic pregnancy with hx of PID is increased as much as
7-10 fold and approximately 20% of woemn develop chronic pelvic pain during their lifetime.
clinical manifestations of acute salpingitis is abdominal / pelvic/adnexal pain. other symptoms include
increased vaginal discharge, abnormal odor, abnormal bleeding, gastrointestinal disturbances, and urinary tract symptoms.
PID can lead to serious sequelae (infertility) therefore
a low threshold for diagnosis and treatment should be maintained.
Minimum criteria for empiric treatment include pelvic/ lower abdominal pain in sexually active young women, or women at risk for STIs, and one or more of the following:
cervical motion tenderness, uterine tenderness, or adnexal tenderness.
additional diagnostic criteria that supports dx of PID include fever, abnormal cervical or vaginal mucopurulent discharge, abundant WBC on saline microscopy of vaginal secretions, elevated ESR, elevated c-reactive protein and cervical Neisseria gonorrhoeae or Chlamydia trachomatis infections.
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cervical cultures are performed to find a causative organism but, because of the disease’s polymicrobial nature, should not dictate the treatment regimen.
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principal organisms suspected of causing PID are
N. gonorrhoeae and C. trachomatis. these 2 organisms together account for approximately 40% of all PID cases. HOWEVER, cultures from upper reproductive tract have shown that PID is likely to be polymicrobial.
treatment of PID. high rate of ambulatory treatment failures and seriousness of sequelae. pts are often
hospitalized for treatment. PID treated with broad spectrum cephalosporin such as cefoxitin 2g IV. then doxycycline 100mg orally bid x 14 days.
persistent PID can lead to development of
tubo-ovarian abscess. TOA.
diagnosis of TOA
adnexal or posterior cul de sac mass / fullness. most pts will have abdomial / pelvic pain and demonstrate fever and leukocytosis. WBC elevated, ESR elevated.
treatment of TOAs can be medical or surgical. medical management
broad spectrum antibiotics in an inpatient setting. Unless abscess is ruptured and causing peritoneal signs or is impenetrable by antibiotics, surgical treatment can be AVOIDED.
If responsive to IV meds, pts can be converted to oral antibiotics to complete a 10-14 day course with doxycycline plus clindamycin or metronidazole.
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toxic shock syndrome
caused by infection with specific strains of staphylococcus aureus that produce an epidermal toxin
symptoms of TSS
high fever (102F), hypotension, diffuse erythematous macular rash, desquamation of palms and soles 1-2 weeks after acute illness, multisystem involvement of 3 or more organ systems.
treatment of TSS
highest priority is supportive treatment of hypotension with IV fluids and pressors if needed. this disease is caused by the EXOTOXIN. treatment with IV antibiotics does not often shorten the length of acute illness.
outpatient treatment of PID
ceftriaxone 250mg IM plus doxycyline 100mg orally bid x 14 days.
