STIs and PID Flashcards
Who gets chlamydia and gonorrhea, mostly?
Adolescents and young adults.
What are the 2 main organisms responsible for PID?
Chlamydia and Gonorrhea
What’s the best way to test for most STDs?
Nucleic acid tests.
What cells of the cervix does N. gonorrhea mainly infect?
Glandular cells
What’s more likely to be symptomatic Gonorrhea in men or women?
Gonorrhea in men. Often asymptomatic in women (no itching, burning, etc.)
Micro review: N. gonorrhea morphology, staining, culture?
Gram-negative diplococci.
Fastidious growth culture: Low O2, Thayer-Martin or chocolate agar.
Contraction rate per exposure for women vs. men?
50% contraction rate for women.
20% contraction rate for men.
Do you usually need to give pelvic exams to adolescents?
Nope. Testing for STIs can be done with nucleic acid tests on urine.
What’s Chlamydia’s lifestyle like, and how is that related to the pathology it causes?
Intracellular. The pathology is more caused by the immune response to infected tissue.
Cells seen in the immune response to Chlamydia?
PMNs
Lymphocytes (mainly T cells)
Plasma cells
2 things Chlamydia causes in men?
Non-gonococcal urethritis.
Epididymitis
4 things Chlamydia causes in women?
Cervicitis
Endometritis
Salpingitis
Infertility
What’s the most frequently reported STI in the US?
Chlamydia
What’s the predominant commensal organism in the vaginal mucosa? What do they do?
Lactobacilli. They make peroxides -> acidic pH of vagina.
What’s cervical mucus got to do with STIs?
When it’s thick, organisms may have trouble ascending up to the uterus / Fallopian tubes.
(thus, progestins may be somewhat protective against PID)
If sperm can get to the peritoneal cavity after sex…
…so can other organisms.
3 subdivisions of PID?
Endometritis
Salpingitis
Oophoritis
What do normal flora have to do with PID? Implication for treatment of PID?
Chlamydia and Gonorrhea can alter the environment such that these other organisms cause a problem as well.
PID must be treated with broader spectrum ABx than is used for cervicitis.
What is the adnexa?
The ovary area of the abdomen, when palpating in a physical exam.
What are the 3 minimum criteria for PID diagnosis?
Lower abdominal pain
Adnexal tenderness
Cervical motion tenderness
What’s a hydrosalpinx?
Contrast injected into uterine cavity doesn’t make it to the peritoneum because the oviducts are blocked.
Several courses that infective salpingitis can follow? (associated conditions?)
Fimbriae remain patent (plicae fusion, ectopic pregnancy)
Spread to ovary (tubo-ovarian abscesses)
Fimbriae become occluded (pyosalpinx -> hydrosalpinx)
What’s the pathological definition of PID?
Chronic salpingitis with spread to ovaries / parametrium.
Adhesions common.
Do IUDs cause or predispose to PID?
No. An IUD no longer on the market was associated with actinomyces, but that’s dead.
Review: Is movement of the ovum / fertilized embryo through the oviduct more about cilia or smooth muscle contraction?
It’s more about the smooth muscle.
Where in the oviduct does ectopic pregnancy most commonly occur?
In the ampulla.
3 complications of tubal ectopic pregnancy?
Tubal abortion (it can actually be expelled out the fimbriae)
Tubal hemorrhage
Tubal rupture.
4 complications of acute PID?
Infertility from tubal scarring
Ectopic pregnancy
Chronic pelvic pain
Abscesses (tubo-ovarian) and peritonitis
When you see lower abdominal pain in women of childbearing age you should…
Rule out (ectopic) pregnancy. Consider PID.
Other than age and not using a barrier, what are 2 predisposing factors for infective salpingitis?
Induced abortion
Any manipulation of the cervix (e.g. IUD placement, if cervicitis present, theoretically)
