STIs and PID

Question 1

What are the two most common STIs

Answer 1

Gonorrhea and chlamydia (primary cause for cervicitis and PID

Question 2

What are some special groups to consider for STI screening/testing?

Answer 2

• Pregnancy
• Adolescents/young adults
• Correctional facilities
• MSM
• WSW
• Sexual abuse

Question 3

What tests do you use for STIs

Answer 3

Nucleic acid amplification tests

Question 4

What organism causes gonorrhea

Answer 4

Neisseria gonorrhoeae, gram neg diplococci

Question 5

Describe gonorrhea

Answer 5

Human disease, asymptomatic with rectal and pharyngeal infections

Question 6

What is the physiology and structure of chlamydia?

Answer 6

• Strict intracellular parasite
• Asymptomatic often (esp in women)
• Small gram negative bacilli
• Re-infection is common

Question 7

What does chlamydia cause in men?

Answer 7

Non-gonococcal urethritis, epidiymitis

Question 8

What does chlamydia cause in women?

Answer 8

Cervicitis

endometritis

salpingitis (inflammation of fallopian tubes)

infertility

Question 9

What is PID?

Answer 9

Inflammation of the endometrium, fallopian tubes, or ovaries. Caused when infectious organisms migrate up the reproductive tract from the cervix

Question 10

Why to GC and CT lead to PID and cervicitis?

Answer 10

• The cervix is lined with columnar/glandular epithelium which is more susceptible to infection while the vagina is lined by squamous epithelium which is more resistant. CT infects glandular cells of the cervix.
• Vaginal flora contains many organisms, especially Lactobacilli which forms a peroxide and makes the vagina acidic. There is lower O2 medium in the cervix that GC thrives in.
• Cervical mucus is a complex glycoprotein with variable water content. It changes with the cycle. During ovulation, it becomes very copious and thin, making it a great medium for CT and GC
• Endometrium is more vulnerable to infection when it is replicating and thick
• Menstrual flow is a good medium, aiding transmission
• Ovaries with large follicles (cysts) can be a nidus for infection
• When GC and CT cause an upper tract infection, they change the environment so bacteria normally present in the vagina become pathogenic

Question 11

What are the signs of PID?

Answer 11

Abdomen: Bilateral lower abdominal tenderness, bowel sounds present

Pelvic Exam: Uterus and adnexia cannot be evaluated due to pain and guarding. Marked cervical motion tenderness. Green purulent fluid copiously noted from cervix.

Fever, elevated white count, inflamed fallopian tube with pus from fimbriated end

Question 12

What is the minimum criteria for diagnosis of PID?

Answer 12

• Lower abdominal pain
• Adnexal tenderness
• Cervical motion tenderness

Question 13

What are 4 complications from acute PID

Answer 13

1. Infertility
2. Ectopic pregnancy
3. Chronic pelvic pain
4. Tubo-ovarian abscess and peritonitis

Question 14

How do we treat PID?

Answer 14

-Broad spectrum antibiotics hitting the many bacterium that can be involved

Question 15

Prevention of PID

Answer 15

Screening and treating and consistent use of condom

Question 16

Who does PID affect?

Answer 16

Young, sexually active women (70% <25 y/o)

Question 17

Describe the 3 possible progressions from acute to chronic salpingitis

Answer 17

1. Fimbrial end remains patent
   - Causes chronic interstitial salpingitis with a thickened tube. May lead to follicular salpingitis, where the plicae fuse inside the tube to form cystic, glandular structures
2. Spreads to ovary
   - Causes tubo-ovarian abscesses. May heal with fibrosis and cause tubo-ovarian mass
3. Occlusion of the fimbrated end
   - Presents the release of tubal content leading initially to pyosalpinx. Eventually progresses to hydrosalpinx when exudate is replaced by clear fluid

Question 18

What is the pathological definition of PID

Answer 18

Chronic salpingitis with involvement of surrounding structures including ovary and paramerium.

Question 19

Describe the pathology of PID

Answer 19

-Sequelae of chronic salpingitis and adhesions on surface of tube, often spreading to serosa of uterus

• Remissions and exacerbations
• Difficult to eliminate

Question 20

Describe the relationship between an IUD and PID

Answer 20

NONE! No increased rate of PID or ectopic pregnancy

Question 21

Describe ectopic pregnancy

Answer 21

Can be due to PID scarring of the Fallopian tubes. Occurs when emryonal implantation occurs anywhere outside uterine cavity. Complications include tubal abortion, tubal heorrhage, and tubal rupture leading to intraabdominal hemorrhage