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
Vaginal candidiasis
Albicans
Candida GalbraTa
Chronic vaginal thrush?
More than 4 per year
Grows into vulva, swabs are negative, but has it
Non-Albicans Candida Rx?
Boric acid pessary, FATAL if oral.
Candidiasis prevalence?
More in high oestrogen if state
Rare in post-menopausal
Progesterone OCP may help
Trichomonas is presentation?
Yellow green ‘FISHY’ smell
Rx of trichomonas is?
Metronidazole
