Upper Female Reproductive Tract and Systemic Infections

Question 1

What is endometritis

Answer 1

Infection of the endometrium, if it invades to the myometrium it is known as endomyometritis

Part of PID

Question 2

When is endometritis seen most commonly

Answer 2

After C-section delivery

Question 3

What are the signs and symptoms of endometritis

Answer 3

Uterine tenderness on bimanual exam, fever, elevated WBC

Question 4

In endemic countries, this cause of endometritis can cause what?

Answer 4

Mycobacterium tuberculosis, infertility

Question 5

What is the diagnosis and treatment of endometritis?

Answer 5

Endometrial biopsy showing plasma cells

Treatment: same is PID ( cefoxitin or cefotetan plus doxy), clinda and gent

Question 6

Define PID

Answer 6

Upper female genital tract infection including endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis

Question 7

What are the symptoms of PID?

Answer 7

Abdominal pain or pelvic/adnexal pain, unilateral or bilateral
vaginal discharge, abnormal odor, abnormal bleeding, GI disturbances, urinary symptoms
fever in 20%

Question 8

Diagnostic criteria of PID

Answer 8

pelvic or lower abdominal pain in sexually active young women, or women at risk for STIs, and one or more of the following:

• CMT
• Uterine tenderness
• Adnexal tenderness

Other:
fever, discharge, WBC, ESR/CRP, cervical GC/C infection

Definitive diagnosis = laparoscopy (to rule out appy), endometrial biopsy, or pelvic imaging with PID findings

Question 9

What is a complication of PID?

Answer 9

Fitz-hugh-curtis disease = perihepatitis resulting in RUQ pain and elevated LFTs

Question 10

What are the most common organisms for PID?

Answer 10

Gonorrhea and chlamydia

also polymicrobial: bacterioides, strep, H flu, e coli, gardnerella

Question 11

Treatment for PID?

Answer 11

Cefotetan/Cefoxitin + Doxy
clinda and gent
metronidazole if GV or trhicomonas

Question 12

What are the sequelae of PID?

Answer 12

Infertility
ectopic pregnancy
chronic pelvic pain
tubo-ovarian abscess (TOA) (increased risk with HIV)

Question 13

Diagnosis of TOA?

Answer 13

Adnexal or posterior cul-de-sac mass/fullness
US
pelvic CT or laparoscopy

Question 14

Treatment of TOA?

Answer 14

Trial of medical management: same as PID
If ruptured or peritoneal signs, then surgery: drainage using US or laparoscopy
Unilateral salpingo-oophorectomy is curative for one-sided
for bilateral, then TAH/BSO

Question 15

What is toxic shock syndrome?

Answer 15

Colonization or infection with specific strains of Staph aureus producing TSST-1 (toxic shock syndrome toxin 1)

Question 16

What are the symptoms of TSS?

Answer 16

Fever > 102
hypotension
diffuse erythematous macular rash
desquamation of palms/soles
multisystem involvement
GI disturbances, myalgias, mucous membrane hyperemia, increased BUN, plt

Question 17

How is TSS treated?

Answer 17

Hospitalization (if severe then ICU)
IV fluids and pressors (supportive)
IV antibiotics (which do not treat the toxins, but decreases risk of recurrence) - clinda and vanc (or linezolid for MRSA) for 10-14 days

Question 18

What is HIV therapy for pregnant mothers?

Answer 18

3 part regimen
zidovudine during pregnancy and labor
HAART
C-section

Breast feeding is contraindicated