PID Flashcards
PID
endometritis, salpingitis, tuba-ovarian abscess and peritonitis
poorly defined and diagnosed
important cause of tubal infertility, ectopic pregnancy and chronic pelvic pain
worse outcome with repeated infections
predisposing causes of PID
sexually acquired, post delivery, post instrumentation, UTIs
more likely causes of PID
gonorohea, chlamydia, anaerobes, mycobacterium and ureaplasma, actinomyces, TB
symptoms of PID
many asymptomatic early in disease bilateral pelvic pain RUQ pain - bugs spill into peritoneum and end up around the liver vaginal dichagre low back pain irregular veginal bleeding dysuria dyspareunia toxic
signs of PID
abdo tenderness cervicitis cervial excitation adnexal tenderness - usually bilateral fever RUQ tenderness
investigations
high vaginal swab and endocervical swab pregnancy test FBC CRP ultrasound laparoscopy
treating PID
low threshold
over treatment causes few problems
under treatment causes little damage
azithromycin and ceftriazone
continue with doxycycline and metronidazole
epididymitis
pain and swelling in scrotum
torsion of testis may occur - surgical emergency
sexually acquired
UTI
prostatitis
acute, chronic bacterial, chronic non bacterial/prostatodynia
acute bacterial prostatitis
organisms ascend from urethra and urinary bladder
rarely haematogenous spread
chronic prostatitis
may follow acute prostatitis
may develop insidiously
prostatitis treatment
depends on organism if found long term therapy 6-8 weeks anti-inflammatory action of macrolides often persisting symptoms may need alpha blockers or neurogenic pain relief
LGV
lymphogranuloma venereum chlamyda trachamatis previously thought to be tropical proctitis is principal presentation treatment three weeks of doxycycline
primary syphilis
painless ulcer (chancre) on genitalia, perianal area, rectum, pharynx, tongue, lip or elsewhere depending on entry site
non tender enlargement of regional lymph nodes
resolves without treatment
increases risk of HIV
secondary syphilis
six weeks to six months following exposure
generalised maculopapular skin rash in most cases
alpaca/patchy hair loess to scalp and eyebrows
mucous membrane lesions
moist papukeis (condylomas) in moist skin areas
associated generalised non tender lymphadenopathy, may be associated fever
complications of meningitis, haptics, osteitis, arthritis, iritis
often resolves without treatment
early latent syphilis
within two years of exposure
clinical signs and symptoms similar to that of secondary syphilis
lesions of secondary syphilis can heal spontaneously however relapse may occur if untreated or inadequately treated
neurological involvement in secondary syphilis may be symptomatic but neurological relapses in early latent syphilis may be fulminant
late latent syphilis
con occur after 2 years of infection
usually no physical signs however there may be positive serological tests
maybe a history of syphilis which has been inadequately treated
cerebrospinal fluid is negative for trepomonas, and x-ray and physical examination shows no evidence of cardiac involvement
may last from months to a lifetime
patient not infectious
tertiary syphilis
occurs between one to thirty fave years after exposure
causes endarteritis
infiltrative tumours of the skin, bones and liver - gummas
aortitis, aneurysms and aortic regurgitation
affects the central nervous system causing meningovascular and degenerative changes
paresthesias, shooting pains, abnormal reflexes, dementia or psychosis
proprioception loss
duvets or retiniiitis
nerve deafness
congenital syphilis
preventable with early antenatal care
treat mother before 20 weeks if possible
if treatment is later in pregnancy may not be curative
diagnosis of syphili
ulcer PCR is available and can be done with herpes testing
serology
syphilis serology
VDRL/RPR - nontreponemal specific tests which measure titres of specific antibodies directed towards cardiolipi, lecithin and cholesterol
specific antibody tests
EIA - enzyme immunoassay
TPHA/TPPA - T pallidum haemagggllutlnation assay/T pallidum particle agglutination
FTA-Abs - fluorescent treponema antibody absorption
treatment syphilis
infectious syphilis
benzathine penicillin
doxycycline and ceftriaxone
in pregnancy - only penicillin
late latent syphilis - benzathine penicillin for 3 doses
alternative doxycycline for 4 weeks
neurological and tertiary needs IV penicillin
syphilis follow up
if RPR negative prior to treatment, no follow up required
if RPR titre raised prior to treatment requires follow up at 3, 6 and 12 months
garish-herxheimer reaction
flu like illness during treatment of syphilis
