Pelvic inflammatory disease Flashcards
What is pelvic inflammatory disease (PID)?
inflammation and infection of the organs of the pelvis, caused by infection spreading up through the cervix. It is a significant cause of tubular infertility and chronic pelvic pain.
What is endometritis?
Inflammation of endometrium
Difference between endometritis and endometriosis?
Endometriosis is when pieces of your uterine lining develop in places other than the uterus, like your ovaries or fallopian tubes.
Endometritis is inflammation of the lining of the uterus.
What is salpingitis?
Inflammation of fallopian tubes
What is oophoritis?
Inflammation of ovaries
What is parametritis?
Inflammation of the paremetrium (connective tissue around the uterus).
What is peritonitis?
Inflammation of the peritoneal membrane.
Common sexually transmitted causes of PID?
Neisseria gonorrhoeae tends to produce more severe PID
Chlamydia trachomatis
Mycoplasma genitalium
Common non-sexually transmitted causes of PID?
Gardnerella vaginalis (associated with bacterial vaginosis)
Haemophilus influenzae (a bacteria often associated with respiratory infections)
Escherichia coli (an enteric bacteria commonly associated with urinary tract infections)
Risk factors for PID?
Not using barrier contraception
Multiple sexual partners
Younger age
Existing sexually transmitted infections
Previous pelvic inflammatory disease
Intrauterine device (e.g. copper coil)
How can IUD’s cause PID?
IUD insertion introduces temporary microbial contamination into the uterus, thereby bringing about a 6-fold increased risk of PID during the first 20 days after insertion.
Investigations for PID?
To swab for causative organisms and other potentially sexually transmitted disease
NAAT swabs can be done for what conditions and pathogens?
Chlamydia, gonorrhoea and mycoplasma genitalium
What is a high vaginal swab?
medical procedure performed in obstetrics and gynaecology to test vaginal discharge for the presence of vaginal thrush, bacterial vaginosis and trichomonas vaginalis.
What is bacterial vaginosis?
Bacterial vaginosis (BV) refers to an overgrowth of bacteria in the vagina, specifically anaerobic bacteria.
It is not a sexually transmitted infection. It is caused by a loss of the lactobacilli “friendly bacteria” in the vagina.
Bacterial vaginosis does not affect risk of developing STI’s. True/false?
False
Bacterial vaginosis can increase the risk of women developing sexually transmitted infections.
What is lactobacilli?
main component of the healthy vaginal bacterial flora.
These bacteria produce lactic acid that keeps the vaginal pH low (under 4.5). The acidic environment prevents other bacteria from overgrowing.
What happens when there is reduced lactobacilli in the vagina?
pH rises.
This more alkaline environment enables anaerobic bacteria to multiply.
Examples of anaerobic bacteria causing bacterial vaginosis?
Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species
Risk factors that increase chance of developing bacterial vaginosis?
Multiple sexual partners (although it is not sexually transmitted)
Excessive vaginal cleaning (douching, use of cleaning products and vaginal washes)
Recent antibiotics
Smoking
Copper coil
Major feature of bacterial vaginosis?
Foul-smelling (fishy) discharge with watery white or grey vaginal dischage.
Although in around half of cases, patients are asymptomatic
Itching, irritation and pain are typically associated with BV. true/false?
False
Not usually associated and suggests an alternative cause or co-occurring infection.
What pH value does BV usually occur with?
Above pH of 4.5
What types of cells are present with BV on microscopy?
“Clue cells”
These are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.
“Clue cells” on microscopy = BV (bacterial vaginosis)
If bacterial vaginosis is asymptomatic, it doesn’t require treatment and may resolve on it’s own. True/false?
True
What antibiotics may be used in cases where there is symptomatic BV?
Metronidazole is the antibiotic of choice for treating bacterial vaginosis. Metronidazole specifically targets anaerobic bacteria.
This is given orally, or by vaginal gel. Clindamycin is an alternative but less optimal antibiotic choice.
What can bacterial vaginosis increase the risk of?
risk of catching sexually transmitted infections, including chlamydia, gonorrhoea and HIV.
What does bacterial vaginosis increase the risk of in pregnant women?
Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometritis
Management of PID?
Remember: 3 word disease = 3 antibiotics
ceftriaxone, doxycycline and metronidazole
