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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

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





Epidemiology
EPIDEMIOLOGY disorders spread principally by intimate contact

  • 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 disorders spread principally by intimate contact

  • 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 disorders spread principally by intimate contactinflammatory disease

Aerobic

  • Neisseriagonorrhoeae

  • Chlamydia trachomatis The big two

  • Ureaplasmaurealyticum

  • Mycoplasmagenitalium

  • Gardnerellavaginalis

  • Strep. pyogenes

  • Escherichia coli

  • Haemophilusinfluenzae

  • Mycoplasmahominis

  • Strep. pneumoniae

  • Mycobacterium tuberculosis


Anaerobic disorders spread principally by intimate contact

  • Bacteroides sp.

  • Peptostreptococcus sp.

  • Clostridium bifermentans

  • Fusobacterium sp.

    Viruses

  • Herpes simplex

  • Echovirus

  • Coxsackie


Neisseria gonorrhoeae
NEISSERIA GONORRHOEAE disorders spread principally by intimate contact

  • 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 disorders spread principally by intimate contact

  • 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


  • Purulent vaginal discharge. disorders spread principally by intimate contact

  • 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


  • Polyathralgia disorders spread principally by intimate contact

  • Tenosynovitis

  • Dermatitis

  • Conjunctivitis Opthalmia Neonatorum


Male urethral discharge
Male Urethral Discharge disorders spread principally by intimate contact

  • 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 disorders spread principally by intimate contact

  • Discharge – Urethral, Cervical, Anal, Pharynx

  • Thayer-Martins Media

  • Gram Negative Diplococci in leucocytes

  • ELISA

  • Nucleic Acid Amplification Test (NAATs)


Chlamydia trachomatis
CHLAMYDIA TRACHOMATIS disorders spread principally by intimate contact

  • 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 disorders spread principally by intimate contact

  • ASYMPTOMATIC

  • FEVER

  • ABNORMAL VAGINAL DISCHARGE

  • LOWER ABDOMINAL PAIN

  • PAINFUL INTERCOURSE

  • IRREGULAR MENSTRUAL BLEEDING

  • PAINFUL MENSTRUATION

  • CERVICAL MOTION TENDERNESS

  • COMPLICATION ie Infertility


Diagnosis1
DIAGNOSIS disorders spread principally by intimate contact

  • Based solely on lab test

  • Cell Culture isolation: sensitivity= 70-90%

  • Complement Fixation Methods

  • Immunofluorescence

  • DNA Probe


Genital ulcer disease
Genital Ulcer Disease disorders spread principally by intimate contact

Syphilis

Chancroid

Herpes Simplex


Genital herpes vesicles
Genital herpes vesicles disorders spread principally by intimate contact


Typical vaginal discharge caused by trichomoniasis
Typical vaginal discharge caused by trichomoniasis disorders spread principally by intimate contact


Strawberry cervix due to t vaginalis
disorders spread principally by intimate contactStrawberry cervix” due to T. vaginalis


Physicians role
PHYSICIANS’ ROLE disorders spread principally by intimate contact

  • 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


Essential Steps In STI Care Management* disorders spread principally by intimate contact

Syndrome

Assessment

Contact tracing

Compliance

Confidentiality

Condom use

Counseling

(diagnostic tools)

5Cs

Diagnosis

Treatment

(screening tests)

Risk

Assessment


Antibiotic rx
ANTIBIOTIC Rx disorders spread principally by intimate contact

  • CEPHALOSPORINS

    • Cefuroxime

    • Ceftriaxone

    • Cefpodoxime eg Orelox

  • MACROLIDES

    • Azithromycin

  • TETRACYCLINS

    • Doxycycline

  • FLUOROQUINOLONES

    • Ciprofloxacin, Levofloxacin, Ofloxacin


Urinary tract infection
URINARY TRACT INFECTION disorders spread principally by intimate contact

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

  • Urethritis - Urethra

  • Cystitis – Bladder

  • Pyelonephritis - Kidneys


Risk factors
Risk factors disorders spread principally by intimate contact

  • Women

    • Anatomy

    • Sexual intercourse

    • Pregnancy

  • Catheterization

  • Bladder/Kidney stones

  • Immunosuppression

  • Stroke/Bedridden

  • Family history

  • Diabetes Mellitus


Causes
CAUSES disorders spread principally by intimate contact

  • E. Coli - 80 – 85%

  • Klebsiella

  • Pseudomonas

  • Proteus

  • Enterobacter

  • Rarely – Viruses and Fungi


Symptoms signs1
SYMPTOMS & SIGNS disorders spread principally by intimate contact

  • 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….. disorders spread principally by intimate contact

  • In the Elder Post-menopausal

    • Incontinence

    • Altered sensorium

    • Fatigue

    • Sepsis

    • Plus earlier symptoms


Diagnosis2
DIAGNOSIS disorders spread principally by intimate contact

  • 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 disorders spread principally by intimate contact

  • 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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