PID Flashcards
2 ways to get it
Sexually: chlamydia
Non-SExually: endogenous
-post surgical
Why pelvic ultrasound in PID?
Check for pyosalpinges, oophritis, Cervicitis
The most common presentation of chlamydia?
ASYMPTOMATIC
How many chlamydia go symptomatic?
10% of symptomatic infections progress to PID
Rx for chlamydia?
Azithromycin 1g stat
Resistance is rare
CONTACT TRACING
When do you need test of cure?
If not Rx with Azithromycin?
6-12 weeks
Pregnant women
If getting PID, what Rx? Mod
Ceftriaxone plus metronidazole plus Azithromycin
Then Azithromycin a week later
If Severe PID?
IV antis, admit
Mirena too long in, problems?
- Stuck and infected - 10 years
- No longer have contraception
Actinomyeses? Ix?
Actinomyosis culture (takes 2 weeks) No PCR for it.
PID in IUD RX?
Remove IUD
Antibiotics
If PID with abscess Rx? And she’s unwell.
Drain it. U/S guided
Laparoscopy
Give ABx prior to prevent sepsis
If confirmed actinomyces? Rx?
Prolonged Abx
Colonization: check ID
PID non sexually acquired risks?
Ascending infection
Post surgical, D&C hysterosalpingogram, IUD inserition
Retained products
PID and IUD
Take swabs
Risk of PID doesn’t increase once it’s in.
Mirena may be protective b/c progesterone
if have IUD, and has chlamydia?
Treat and take it out. Test to make sure it’s gone before putting it back in.
especially if nulliparous
Actinomyces Is?
Gram+ve anaerobic bacillus
Normal flora
LOVES IUD colonization
Can cause tubo ovarian abcess, drain: then IV Abx 1-2 days prior.
Cervicitis presentation?
Discharge
Post-coital bleeding
Abnormal Pap smear-inflammatory cells causing abnormal pap
What worries about post-coital bleeding?
Cervical cancer
Most common cause of post-coital bleeding?
Ectropion
If have post-coital bleeding and pap smear is normal, safe?
Nope. Screening test only. Need colposcopy if ongoing symptoms
Likely organism for bacterial vaginosis?
Mixed anaerobes - Endogenous imbalance
What increase risk of bacterial vaginosis?
Douching,
Increasing pH
Sex worker
Vaginosis Rx?
Metronidazole Metronidazole gel Clindamycin Treat only if Symptomatic, pregnant, before gynaecological High recurrence
