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Transmission. • Sexual transmission via the vagina & cervix • Gynecological surgical procedures • Child birth/ Abortion • A foreign body inside uterus (IUCD). Transmission. • Contamination from other inflamed structures in abdominal cavity

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Transmission

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Transmission

Transmission

  • • Sexual transmission

  • via the vagina & cervix

  • • Gynecological

  • surgical procedures

  • • Child birth/ Abortion

  • • A foreign body inside uterus (IUCD)


Transmission

Transmission

  • • Contamination from

  • other inflamed structures

  • in abdominal cavity

  • (appendix, gallbladder)

  • • Blood-borne transmission

  • (pelvic TB)


Transmission

Endometritis (thickened heterogenous endometrium)


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Hydrosalpinx(anechoic tubular structure)


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Hydrosalpinx.


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Pyosalpinx (tubular structure with debris in adnexa


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Tuboovarian abscess resulting from tuberculosis


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Right hydrosalpinx with an occluded left fallopian tube


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Definitive Criteria (CDC 2002)

• Endometrial biopsy with histopathology evidence of endometritis

• TVS/ MRI: Thickened fluid filled tubes/

free pelvic fluid / tubo-ovarian complex

• Laparoscopic abnormalities consistent with PID


Transmission

When should treatment be stopped ?

• Parenteral changed to oral therapy after 72 hrs, if substantial clinical improvement

• Continue Oral therapy until clinical & biological signs (leukocytosis, ESR, CRP) disappear or for at least 14 days

• If no improvement, additional diagnostic tests/ surgical intervention for pelvic mass/ abscess rupture


Transmission

Associated treatment

Rest at the hospital or at home

Sexual abstinence until cure is achieved

Anti-inflammatory treatment

Dexamethasone 3 tablets of 0.5 mg a day

or Non steroidal anti-inflammatory drugs

Oestro-progestatives: contraceptive effect

+ protection of the ovaries against a peritoneal inflammatory reaction +

cervical mucus induced by OP has preventive effect against re-infection.


Transmission

Special Situations

Pregnancy

- Augmentin or Erythromycin

- Hospitalization

Concomitant HIV infection

- Hospitalization and i.v. antimicrobials

- More likely to have pelvic abscesses

- Respond more slowly to antimicrobials

- Require changes of antibiotics more often

- Concomitant Candida and HPV infections


Transmission

Surgery in PID

Indications

Acute PID

-Ruptured abscess

- Failed response to medical treatment

- Uncertain diagnosis

Chronic PID

- Severe, progressive pelvic pain

- Repeated exacerbations of PID

- Bilateral abscesses / > 8 cm. diameter

- Bilateral uretral obstruction


Transmission

Management of sex partners

• Examination and treatment

if they had sexual contact

with patients during the 60 days preceding the onset of symptoms

in the patients.

• Empirical treatment with regimens

effective against C. trachomatis

and N. gonorrhoeae


Transmission

Prevention

  • Primary Prevention:

  • - Sexual counseling: practice safe sex, limit the number of partners, avoid contact with high-risk partners, delay the onset of sexual activity until ≥ 16 years.

  • - Barrier and Oral contraceptives reduce the risk for developing PID.

  • Secondary Prevention:

  • • - Screening for infections in high- risk.

  • - Rapid diagnosis and effective treatment of STD and lower urinary tract infections.

  • Tertiary Prevention:

  • -Early intervention & complete treatment.


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