INFECTIONS: UPPER GENITAL TRACT Flashcards
enumerate
Major risk factors of endometritis
- Douching: past 30 days
- Douching: day 1-7 of menstrual cycle
- IUD
- Commonly w/ salpingitis
identify
Most common organisms associated with endometritis
C. trachomatis
N. gonorrhea
identify
Most prevalent organism positive in PID
C. trochomatis
identify
Gold standard for diagnosing endometritis
Endometrial biopsy
enumerate
Histopathologic criterion for endometritis
- at least 1 plasma cell/x120 in endometrial stroma
- 5 or more neutrophils /x400 in superficial endometrium
- Diffuse lymphocytes in endometrial stroma/stromal necrosis
identify
Treatment for endometritis
antimicrobial therapy
* CEFIXIME 400mg oral
* AZITHROMYCIN 1000mg/ 1g QID
with or without
* METRONIDAZOLE 500mg oral, 2x for 7 days
identify causative agent in PID
- Most damage occurs to ciliated cells
- COMPLEMENT mediated tissue damage
- Scarring & tubal adhesions
N. gonorrhea
identify causative agent
- Increases risk of ectopic pregnancy
- CELL mediated tissue destruction
- Slow onset, less pain, low fever
C. trachomatis
identify associated organism
Chlamydial heat shock protein
* Severe tubal scarring
* Fitz-Hugh Curtis syndrome
C. trachomatis
Adhesions between the liver and diaphragm indicating prior peritonitis
FITZ HUGH CURTIS SYNDROME
A young sexually active woman diagnosend with PID. With route of spread via parametria and tubal mucosa sparing ascending infection. What organism/s are associated?
mycoplasma hominis
Ureaplasma urealyticum
Definitive criteria for diagnosing PID
- Histopathologic evidence
- Transvaginal sonography/ MRI - thickened fluid filled tubes
- Laparoscopic abnormalities
Advantages of laparoscopy for PID
- Lysis of adhesions
- Drainage of abscess
- Irrigation of pelvic cavity
Medical management for PID
CEFTRIAXONE 500mg, IM single dose
DOXYCYCLINE 100mg, oral, BID for 14 days
MTERONIDAZOLE 500mg, oral, BID for 14 days
Patient who was wearing IUD for 8 years reported foul-smelling discharge and tested positive for sulfur granules and gram positive filaments. What treatment would be appropriate for the patient?
Oral penicillin/ doxycyline/ fluoroquinalone, 12 weeks (3 mos)
Diagnostic procedure for tuberculosis
Endometrial biopsy - late in the secretory phase
Inidcations for operative therapy in PID
- > 40 y.o.
- w/ resistant organisms
- persistent pelvic masses
- endometrial cultures positive
