Upper Genital Tract Infections

Question 1

Infection of the endometrium

Answer 1

ENDOMETRITIS

ENDOMYOMETRITIS - infection invades myometrium

CHRONIC ENDOMETRITIS - asymptomatic but may lead to other pelvic infections

Question 2

Risk Factors for Endometritis

Answer 2

Retained products of conception
STD
Intrauterine foreign bodies or growths
Instrumentation of the uterine cavity
Minimally invasive transcervical gynecologic procedures
IUD placement

Question 3

Treatment for Endometritis

Answer 3

Clindamycin OR
Cefoxitin

Chronic Endometritis - 10-14 day course of Doxycycline 100 mg BID PO

Question 4

Infection of the upper female genital tract – combination of endometritis, salpingitis, tubo-ovarian abscess (TOA) and pelvic peritonitis

Answer 4

PELVIC INFLAMMATORY DISEASE (PID)

polymicrobial

Question 5

Risk factors of PID

Answer 5

Gross indicators of frequency of exposure to STI and PID:
*age at first coitus, marital status, number of sexual partners

History of STI and PID
Young age - 15-25 y/o
Multiple partners
Recent history of douching
Prior history of PID
Cigarette smoking

Question 6

Most frequent symptom of PID

Answer 6

new onset lower abdominal and pelvic pain

Question 7

5-10% of women with acute PID develop symptoms of perihepatic inflammation

Answer 7

Fitz-Hugh Curtis Syndrome

Question 8

PID Complications

Answer 8

INFERTILITY
1 episode - 12%
2 episode - 20%
3 episode - 40%

Ectopic pregnancy
Chronic pelvic pain
Dyspareunia
Pelvic adhesions

Question 9

Parenteral Treatment for PID

Answer 9

Cefotetan + Doxycycline
Cefoxitin + Doxycycline
Clindamycin + Gentamicin

Question 10

Intramuscular/ Oral Treatment for PID

Answer 10

Ceftriaxone + Doxycycline w/ or w/o Metronidazole

Cefoxitin and Probenecid + Doxycycline w/ or w/o Metronidazole

3rd gen Cephalosporin (Ceftizoxime or Cefotaxime) + Doxycycline w/ or w/o Metronidazole

Question 11

Sequelae of persistent PID

Answer 11

TUBO-OVARIAN ABSCESS (PYOSALPIX)

3-16% - progression from PID - TOA

Tubo-ovarian complexes (TOC) - not walled off like true abscess and thus are more responsive to antimicrobial therapy