STIs and PID Flashcards
What are the two most common STIs
Gonorrhea and chlamydia (primary cause for cervicitis and PID
What are some special groups to consider for STI screening/testing?
- Pregnancy
- Adolescents/young adults
- Correctional facilities
- MSM
- WSW
- Sexual abuse
What tests do you use for STIs
Nucleic acid amplification tests
What organism causes gonorrhea
Neisseria gonorrhoeae, gram neg diplococci
Describe gonorrhea
Human disease, asymptomatic with rectal and pharyngeal infections
What is the physiology and structure of chlamydia?
- Strict intracellular parasite
- Asymptomatic often (esp in women)
- Small gram negative bacilli
- Re-infection is common
What does chlamydia cause in men?
Non-gonococcal urethritis, epidiymitis
What does chlamydia cause in women?
Cervicitis
endometritis
salpingitis (inflammation of fallopian tubes)
infertility
What is PID?
Inflammation of the endometrium, fallopian tubes, or ovaries. Caused when infectious organisms migrate up the reproductive tract from the cervix
Why to GC and CT lead to PID and cervicitis?
- 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
What are the signs of PID?
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
What is the minimum criteria for diagnosis of PID?
- Lower abdominal pain
- Adnexal tenderness
- Cervical motion tenderness
What are 4 complications from acute PID
- Infertility
- Ectopic pregnancy
- Chronic pelvic pain
- Tubo-ovarian abscess and peritonitis
How do we treat PID?
-Broad spectrum antibiotics hitting the many bacterium that can be involved
Prevention of PID
Screening and treating and consistent use of condom
Who does PID affect?
Young, sexually active women (70% <25 y/o)
Describe the 3 possible progressions from acute to chronic salpingitis
- 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 - Spreads to ovary
- Causes tubo-ovarian abscesses. May heal with fibrosis and cause tubo-ovarian mass - 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
What is the pathological definition of PID
Chronic salpingitis with involvement of surrounding structures including ovary and paramerium.
Describe the pathology of PID
-Sequelae of chronic salpingitis and adhesions on surface of tube, often spreading to serosa of uterus
- Remissions and exacerbations
- Difficult to eliminate
Describe the relationship between an IUD and PID
NONE! No increased rate of PID or ectopic pregnancy
Describe ectopic pregnancy
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
