Pelvic infections urinary tract infection
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PELVIC INFECTIONS & URINARY TRACT INFECTION. DR. AKINWUNMI L. AKINWUNTAN MBBS (Ibadan), MHS Pop. & RH (Ibadan), FMCOG (Nig), FWACS OBSTETRICIAN & GYNAECOLOGIST. INTRODUCTION.

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PELVIC INFECTIONS & URINARY TRACT INFECTION

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Pelvic infections urinary tract infection

PELVIC INFECTIONS & URINARY TRACT INFECTION

DR. AKINWUNMI L. AKINWUNTAN

MBBS (Ibadan), MHS Pop. & RH (Ibadan), FMCOG (Nig), FWACS

OBSTETRICIAN & GYNAECOLOGIST


Introduction

INTRODUCTION

  • Pelvic inflammatory disease (or disorder) (PID) is a term for inflammation of the uterus, fallopian tubes, and/or ovaries

  • It progresses to scar formation with adhesions to nearby tissues and organs

  • PID is a vague term and can refer to viral, fungal, parasitic, though most often bacterial infections


Acute salpingitis

Acute Salpingitis


Pelvic infections urinary tract infection

  • STI or STD is often the cause, many other routes are possible, including lymphatic, postpartum (miscarriage or abortion) or intrauterine device (IUD) related, and hematogenous spread


Pelvic infections urinary tract infection

  • The term "sexually transmitted diseases" is used to denote disorders spread principally by intimate contact

  • Although this usually means sexual intercourse, it also includes close body contact, kissing, cunnilingus, anilingus, fellatio, mouth–breast contact, and anal intercourse


Epidemiology

EPIDEMIOLOGY

  • In the United States , more than 750,000 women are affected by PID each year, and the rate is highest with teenagers and first time mothers

  • PID causes over 100,000 women to become infertile in the US each year

  • About 2% of young women in the UK give a history of PID if asked, and about 1 in 50 consultations with general practitioners made by young women relate to PID


Epidemiology1

EPIDEMIOLOGY

  • RISK FACTORS:

    • Young age

    • Multiple sex partners

    • Lack of condom use

    • Low Socio-economic class

    • Blacks/Caribbean origin

    • Genetics- HLA subtype A31 compared with HLA DQA 0501 and DQB 0402

    • ??? Bacterial Vaginosis

    • Indiscriminate/Improper use of antibiotics


Organisms associated with pelvic in ammatory disease

Organisms associated with Pelvic inflammatory disease

Aerobic

  • Neisseriagonorrhoeae

  • Chlamydia trachomatis The big two

  • Ureaplasmaurealyticum

  • Mycoplasmagenitalium

  • Gardnerellavaginalis

  • Strep. pyogenes

  • Escherichia coli

  • Haemophilusinfluenzae

  • Mycoplasmahominis

  • Strep. pneumoniae

  • Mycobacterium tuberculosis


Pelvic infections urinary tract infection

Anaerobic

  • Bacteroides sp.

  • Peptostreptococcus sp.

  • Clostridium bifermentans

  • Fusobacterium sp.

    Viruses

  • Herpes simplex

  • Echovirus

  • Coxsackie


Neisseria gonorrhoeae

NEISSERIA GONORRHOEAE

  • Neisseriagonorrhoeae is a gram negative diplococcus

  • Can be seen on microscopy as pairs of red kidney-shaped organisms mostly sitting within polymorphs

  • Isolated in 40–60% of women with acute salpingitis

  • It initially infects the cervix but ascends the upper genital tract in 10 -20% of untreated cases


Symptoms signs

SYMPTOMS & SIGNS

  • Most women with gonorrhea are asymptomatic

  • When symptoms occur, they are localized to the lower genitourinary tract and include:

    • vaginal discharge, urinary frequency or dysuria, and rectal discomfort

    • Vulva/Vaginal itching

  • The incubation period is only 3–5 days

  • Bartholinitis

  • Acute Pharyngitis/Tosillitis


Pelvic infections urinary tract infection

  • Purulent vaginal discharge.

  • Urinary frequency and dysuria

  • Recovery of organism in selective media

  • May progress to pelvic infection or disseminated infection

  • The organism may be recovered from the urethra, cervix, anal canal, or pharynx


Pelvic infections urinary tract infection

  • Polyathralgia

  • Tenosynovitis

  • Dermatitis

  • Conjunctivitis Opthalmia Neonatorum


Male urethral discharge

Male Urethral Discharge

  • Discharge coming from the urethral meatus

  • May be frank pus, mucopurulent, or serous (clear)

  • Occasionally discharge will be white in colour

Gonococcal urethral discharge


Diagnosis

DIAGNOSIS

  • Discharge – Urethral, Cervical, Anal, Pharynx

  • Thayer-Martins Media

  • Gram Negative Diplococci in leucocytes

  • ELISA

  • Nucleic Acid Amplification Test (NAATs)


Chlamydia trachomatis

CHLAMYDIA TRACHOMATIS

  • Is estimated to be the cause in about 60% of cases of salpingitis which may lead to PID

  • Chlamydiae are obligate intracellular microorganisms that have a cell wall similar to that of gram-negative bacteria

  • They are classified as bacteria and contain both DNA and RNA

  • Like viruses they grow intracellularly


Clinical presentation

CLINICAL PRESENTATION

  • ASYMPTOMATIC

  • FEVER

  • ABNORMAL VAGINAL DISCHARGE

  • LOWER ABDOMINAL PAIN

  • PAINFUL INTERCOURSE

  • IRREGULAR MENSTRUAL BLEEDING

  • PAINFUL MENSTRUATION

  • CERVICAL MOTION TENDERNESS

  • COMPLICATION ie Infertility


Diagnosis1

DIAGNOSIS

  • Based solely on lab test

  • Cell Culture isolation: sensitivity= 70-90%

  • Complement Fixation Methods

  • Immunofluorescence

  • DNA Probe


Genital ulcer disease

Genital Ulcer Disease

Syphilis

Chancroid

Herpes Simplex


Genital herpes vesicles

Genital herpes vesicles


Typical vaginal discharge caused by trichomoniasis

Typical vaginal discharge caused by trichomoniasis


Strawberry cervix due to t vaginalis

“Strawberry cervix” due to T. vaginalis


Physicians role

PHYSICIANS’ ROLE

  • Understand the microbiology of STDs in order to appropriately diagnose and treat patients

  • To alleviate the symptoms and prevent future sequelae

  • To prevent the transmission to others including health care professionals

  • To do all of the above combined with patient education and counseling


Pelvic infections urinary tract infection

Essential Steps In STI Care Management*

Syndrome

Assessment

Contact tracing

Compliance

Confidentiality

Condom use

Counseling

(diagnostic tools)

5Cs

Diagnosis

Treatment

(screening tests)

Risk

Assessment


Antibiotic rx

ANTIBIOTIC Rx

  • CEPHALOSPORINS

    • Cefuroxime

    • Ceftriaxone

    • Cefpodoxime eg Orelox

  • MACROLIDES

    • Azithromycin

  • TETRACYCLINS

    • Doxycycline

  • FLUOROQUINOLONES

    • Ciprofloxacin, Levofloxacin, Ofloxacin


Urinary tract infection

URINARY TRACT INFECTION

  • A urinary tract infection (UTI) is a bacterial inflammation in the urinary tract

  • Urethritis - Urethra

  • Cystitis – Bladder

  • Pyelonephritis - Kidneys


Risk factors

Risk factors

  • Women

    • Anatomy

    • Sexual intercourse

    • Pregnancy

  • Catheterization

  • Bladder/Kidney stones

  • Immunosuppression

  • Stroke/Bedridden

  • Family history

  • Diabetes Mellitus


Causes

CAUSES

  • E. Coli - 80 – 85%

  • Klebsiella

  • Pseudomonas

  • Proteus

  • Enterobacter

  • Rarely – Viruses and Fungi


Symptoms signs1

SYMPTOMS & SIGNS

  • Lower Tract

    • Burning sensation on micturition

    • Frequency

    • Urgency

  • Upper Tract

    • Flank Pain

    • Fever

    • Haematuria/Pyuria

    • Nausea and Vomiting

    • Plus symptoms of the lower tract


Symptom signs

SYMPTOM & SIGNS…..

  • In the Elder Post-menopausal

    • Incontinence

    • Altered sensorium

    • Fatigue

    • Sepsis

    • Plus earlier symptoms


Diagnosis2

DIAGNOSIS

  • HISTORY

  • LAB:

    • Urinalysis – Nitrites, Leucocytes, LeucocyteEsteraces

    • Urine m/c/c – WBCs, RBCs, Bacteria, Colony count ≥ 10,000/colony forming unit

      Asymptomatic bacteriuria : No symptom plus significant count


Treatment

TREATMENT

  • UNCOMPLICATED

    • Oral Antibiotics

    • Cephalosporins eg Cefuroxime (Axacef)

    • Quinolones eg Ciprofloxacin (Cyplox)

    • Usually a 3-5 day course is sufficient

  • PYELONEPHRITIS

    • Requires prolonged medication – Parenteral

    • Ceftriaxone

    • Amoxicillin/Clavulanate


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