Gynae infections

Question 1

PID - What is it?

Answer 1

= Pelvic Inflammatory Disease

Pelvic inflammatory disease is a general term for infection of the upper genital tract. Infection spreads upwards from the endocervix causing one or more of the following: cervicitis, endometritis, salpingitis, oophoritis, parametritis

Question 2

PID - Risk factors

Answer 2

• More than one sexual partner
• New partner within last 3 months
• Have a sexual partner who has a number or who had a number of sexual partners
• STD untreated
• PID in the past
• Sexually active at a young age
• Douche
• IUD
• Rarely instrumentation of the uterus

Question 3

PID - S&S

Answer 3

o	Pelvic or abdominal pain (bilateral) 
o	Deep dyspareunia 
o	Abnormal vaginal bleeding (inter-menstrual, post coital, breakthrough) 
o	Abnormal discharge 
o	Chronic pelvic pain 16-18%

Question 4

PID - Ix & Dx

Answer 4

o Case history
o Endocervical swabs
o High vaginal swab
o Bloods: Rule out other pelvic pathologies e.g. ectopic, miscarriage, appendicitis

Question 5

PID - Tx

Answer 5

o Managed by genito-urinary or sexual health clinic
o Empirical antibiotics
o Screen for other infections
o Trace sexual contacts
o Sexual abstinence until completed course of treatment or barrier method analgesia

Question 6

PID - Prevention

Answer 6

o Barrier methods
o Early medical treatment if symptomatic
o Combined OCP- thickens cervical mucosa plug
o Tracing and treating previous infected partners
o Abstinence

Question 7

Cervicitis - infective causes

Answer 7

gonococcus
streptococcus
staphylococcus
aerobic and anaerobic
herpes virus
chlamydia

Question 8

Cervicitis - non-infective causes

Answer 8

allergies e.g. Latex
chemicals
trauma
malignancy
hormonal imbalance (high progesterone and/or low oestrogen alter normal flora)

Question 9

Cervicitis - S&S

Answer 9

o	Purulent foul-smelling discharge 
o	Itching or burning sensation 
o	Pelvic pain 
o	Abnormal vaginal bleeding (inter-menstrual, post-coital, ‘break through’) 
o	Painful urination 
o	Fever 
o	Dyspareunia

Question 10

Cervicitis - Acute Ix & Tx

Answer 10

Management:

• Physical exam
• Case history
• Cultures (90% are positive for N. Gonorrhoea)
• Cytological smear
• Abdominal palpation- tender

Treatment ➤ based on culture results

Question 11

Cervicitis - Chronic Ix & Tx

Answer 11

• Lacerations to cervix
• Ulceration with vesicular lesions (sign of Herpes Simplex)
• Usually- staph or streptococcus

Treatment ➤ appropriate medication for infective organism, cauterisation, cone biopsy

Question 12

Cervicitis - Tx

Answer 12

o Recur in 8-25% patients
o Infective- appropriate antibiotics, anti-fungals or anti-virals
o Removal of allergy causing chemical

Question 13

Endometritis - What is it?

Answer 13

Pathological diagnosis- infiltration of the normal vascular architecture by inflammatory cells- can be on surface or spread into stroma

Question 14

Endometritis - S&S

Answer 14

• Asymptomatic- more common if on OCP
• Lower abdominal pain more common first 3 weeks of menstrual cycle
• Pyrexia
• Discharge and/or abnormal bleeding
• Vaginal douching - ?Removal of normal flora in vagina
• Postpartum- 1-3% vaginal births, 27% caesarean

Question 15

Endometritis - Tx

Answer 15

• Post-partum treatment - Cochrane review- IV antibiotics often in combination eg gentamicin, clindamycin
• Appropriate antibiotics (eg cephalosporin’s)
• Surgery can result in hysterectomy

Question 16

Oophoritis & Salpingitis - S&S

Answer 16

Abnormal vaginal discharge
Abdominal pain
Secondary dysmenorrhoea
Dyspaerunia
Low back pain
Fever
Nausea
Vomiting

Question 17

Oophoritis & Salpingitis - Infective causes

Answer 17

N. Gonorrhoea
Chlamydia trachomatis
Mycoplasma
Staphylococcus
Streptococcus
Anaerobic and aerobic organisms eg Tb

Question 18

Oophoritis & Salpingitis - Tx

Answer 18

Antibio

Question 19

Oophoritis & Salpingitis - Cx

Answer 19

Death
Infertility
Ectopic pregnancy
Abscess of the ovary