Lecture 13: STI and PID, Pathophysiology and Pathology Flashcards
What are the STIs to consider that usually require lab detection/diagnosis?
- Chlamydia trachomatis
- Neisseria gonorrheae
- Syphilis
- herpes simplex
- Hepatitis B/C
- HIV
- HPV
- Trichomonas (parasite)
- ulcers
What are the high risk groups for STI?
Adolescent/pregnant
Correctional facilities
Gay and lesbian
Sex abuse
What does nulligravid mean?
Woman has never been pregnant
What does vaginal flora contain?
- streptococci
- staph
- Klebsiella
- E. coli
- Proteus, lactobiacilli
What causes the acidic pH in vagina?
Lactobacilli produces peroxide
Where in the cervix is infection most common?
Squamo-columnar junction
What are the characteristics of Neisseria gonorrhoeae?
Gram negative DiploCocci
Fastidious growth requirements
Gonorrhea in men is symptomatic, asymptomatic in women
What are the characteristics of Chlamydia?
Gram-negative bacilli
Inflammatory response
What are symptoms of chlamydia in women?
- Cervicitis
- Endometritis
- Salpingitis
- Infertility
What is LGV?
Lymphogranuloma venereum
Infection of lymphatics caused by chlamydia
What laboratory techniques are used for GC and chlamydia?
NAAT
Nucleic acid amplification test
Used to test: chlamydia, gonorrhea, herpes, trichomonas, HPV
You can’t tell from looking at cervicitis
Serologic tests are used for syphilis and Hep B/C
What are the different types of pelvic inflammatory disease (PID)?
- Endometritis (endometrium)
- Salpingitis (Fallopian tube)
- Oophoritis (Ovary)
What is the cervical motion tenderness?
That if you touch that point and the patient moves
What is adnexa?
Parts adjoining an organ
What is the minimum criteria for diagnosis of PID?
- lower abdominal pain
- Adnexal (adjoining) tenderness
- Cervical motion tenderness
Upper reproductive tract inflammation
What are the additional criteria for diagnosis of PID?
- fever
- elevated white count
- pus from cervix, mucopurulent cervicitis
- Isolation/detection of gonorrhea and/or chlamydia
- laparoscopic finding of inflamed fallopian tube with pus from fimbriated end
What are the principles of treatment of PID?
Broad spectrum antibiotics which are effective against gonorrhea, chlamydia, as well as the endogenous vaginal and lower GI flora such as anaerobic Bacteroides fragilis, and gram negative and gram positive aerobes
What are the complications of acute PID?
- Infertility caused by tubal scarring, pyosalpinx, hydrosalpinx, distal tubal occlusion, scarring
- ectopic pregnancy
- chornic pelvic pain
- tubo-ovarian abscess and peritonitis
When should you consider diagnosis of PID?
Consider the diagnosis of PID in ALL sexually active women of reproductive age who present with lower abdominal pain
When do you screen for gonorrhea/chlamydia?
Screen for asymptomatic gonorrhea and chlamydia in sexually active men and women under 25
What is a pyosalpinx?
When fimbria fuses with ovary
Is PID associated with IUD insertion?
NO
With new devices, there is no increased rate of PID or ectopic pregnancy
What is hydrosalpinx?
Distally blocked fallopian tube filled with serous or clear fluid
What is the most salient potential sequelae of PID due to post-inflammatory damage to fallopian tubes?
Ectopic pregnancy
What are the routes of progression from acute to chronic salpingitis?
- fimbrial end remains patent (tube thickened and plicae fused together
- Spread to ovary
- tubo-ovarian abscess
- Occlusion of the fimbriated end
- pysalpinx
- hydrosalpinx
What is the main complication of PID?
Blocking of fallopian tube by inflammation and scarring! INFERTILITY
What is the pathologic definition
Of PID?
Chronic salpingitis with involvement
Of surrounding structures including ovary
And parametrium
What is the significance of actinomyces israelii?
Is associated with IUD
What is the natural history of tubal frequency?
- tubal abortion (expelled from fimbrial end of tube)
- Tubal hemorrhage
- Tubal rupture
