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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

  • • 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

  • (appendix, gallbladder)

  • • Blood-borne transmission

  • (pelvic TB)


Endometritis (thickened heterogenous endometrium)


Hydrosalpinx(anechoic tubular structure)


Hydrosalpinx.


Pyosalpinx (tubular structure with debris in adnexa


Tuboovarian abscess resulting from tuberculosis


Right hydrosalpinx with an occluded left fallopian tube


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


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


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.


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


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


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


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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