PID and STIs Flashcards
define pelvic inflammatory disease?
Infection ABOVE the cervix (upper genital tract)
what are the main causative pathogens that cause STI induced PID?
chlamydia, gonorrhoea, mycoplasma, trichomonas
define hydrosalpinx
fluid in the fallopian tube –> can cause issues with fertility
what are the likely organisms for bacterial vaginosis?
BV refers to an imbalance of endogenous flora which may cause localised infection, not systemic infection
what antibiotics do we use for bacterial vaginosis?
metronidazole or clindamycin (both in the form of vaginal gels/creams)
when do we treat bacterial vaginosis?
if the patient is symptomatic
If the patient is pregnant
before any gynaecological procedure
what is another causative pathogen for candidiasis (thrush) other than candida albicans
candida glabrata
define chronic vaginal candida infection?
more than 4 episodes per year
how can we treat acute candidiasis?
acute episode–> caneston (clotrimazole 10%) vaginal cream or single dose fluconazole orally 150mg
a young woman comes in with chronic vaginal candidiasis. she is on the COCP. what can we do to reduce recurrence rates of thrush?
change to progesterone only contraception
as candida usually likes high oestrogenic environments
what are some risk factors for vulvovaginal candidiasis
long-term broad-spectrum antibiotics, diabetes, oestrogen therapy (e.g. the pill, hormone replacement therapy) and stress.
what is a complication of chlamydia/gonorrhoea infection causing PID that we can see on laparoscopy?
Fitz-Hugh–Curtis syndrome, a complication of CT and NG infections, results in perihepatitis and the formation of ‘violin string’ adhesions surrounding the liver.
what are some clinical examination findings which may raise suspicion of PID?
- cervical motion tenderness (‘excitation’)
• uterine tenderness
• adnexal tenderness - temperature > 38.3°C
- cervical or vaginal mucopurulent discharge
how to manage chlamydia infection?
- Reportable infection
- Azithromycin 1g stat (repeat in 1 week if symptomatic)
- Contact tracing
- A test of cure usually not required but should be obtained in pregnant women, patients with persistent symptoms
- If severe then ceftriaxone 1g IV plus metronidazole 500mg IV plus azithromycin 500mg IV daily; IV antibiotics for 48 hrs
which pathogen is associated with IUDs?
actinomyces
what are some clinical features of cervicitis?
postcoital bleeding
vaginal discharge
abnormal pap smear
how do we treat non-albicans related candidiasis?
boric acid vaginal plessary inserted for 10-14 nights
how do you manage a tubo-ovarian abscess secondary to PID?
Abscess needs to be drained or surgically removed
Should have 24-48 hours of IV antibiotics before drainage
what are some non-sexually acquired causes of PID?
endogenous pathogen
post surgical (hysteroscopy D&C, insertion of IUD)
retained products of conception
what is the antibiotic management of mild-moderate sexually acquired PID?
Ceftriaxone 500mg in 2mL of 1% lignocaine IMI, or 500 mg IV, stat PLUS Metronidazole 400mg PO, BD for 14 days PLUS Azithromycin 1g PO, stat PLUS Doxycycline 100mg PO, BD for 14 days
can be done as an outpatient
what is the antibiotic management of severe sexually acquired PID?
Ceftriaxone 2g IV, daily OR Cefotaxime 2g IV, TDS PLUS Azithromycin 500mg IV, daily PLUS Metronidazole 500mg IV, BD
inpatient admission usually required
how do we manage actinomyces infection causing PID?
often long term (approx 6 months) course of penicillin based antibiotics with infectious diseases team
how do we treat chronic vaginal candidiasis?
fluconazole 150mg oral weekly for 3 months
when do we need a test of cure for chlamydia infection post appropriate antibiotic treatment?
when the patient is pregnant or has persistent symptoms or has had suboptimal antibiotic management
