10.3 pid - epi

8/13/2019 10.3 PID - EPI

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PELVICINFLAMMATORY

DISEASE

Fernandez Torres Victor Universidad nacional del centro del peru

8/13/2019 10.3 PID - EPI


PELVIC INFLAMMATORY DISEASE

infection of the uterus, fallopian tubes, andadjacent pelvic structures that is not associatedwith surgery or pregnancy

8/13/2019 10.3 PID - EPI


Etiology and Pathogenesis

2 stages of PID:

-acquisition of a vaginal or cervical infection

-direct ascent of micro-organisms from the

vagina and cervix

ORGANISMS MOST COMMONLY ISOLATED :

• Neisseria gonorrhoeae and Chlamydia trachomatis• Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma

urealyticum, herpes simplex virus-2 (HSV-2), Trichomonas

vaginalis, cytomegalovirus, Haemophilus influenzae, Streptococcus

agalactiae

8/13/2019 10.3 PID - EPI


Risk factors

young age

multiple sexual partners

certain methods of contraception

previous history of chlamydia or another

sexually transmitted infection delayed and decreased access to care

http://emedicine.medscape.com/article/789188-overview

http://emedicine.medscape.com/article/789188-overview

8/13/2019 10.3 PID - EPI


Symptoms

lower abdominal pain

abnormal vaginal discharge

abnormal uterine bleeding

dysuria dyspareunia

nausea

vomiting

fever

Gonococcal PID - dramatic symptoms of fever and

peritoneal irritation

8/13/2019 10.3 PID - EPI


Diagnosis

physical findings: lower abdominal tenderness, adnexal

tenderness, pain on manipulation of the cervix

laboratory studies: ESR, CRP, CBC, gonorrhea DNA probes and

culture, clamydial DNA probes and culture, testes for hepatitis and HIV

imaging studies: transvaginal ultrasonography , CT

procedures: endometrial biopsy

laparoscopy

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Complications

SCARRING INSIDE THE REPRODUCTIVE

ORGANS

CHRONIC PELVIC

PAIN

SPREAD TO IN THE PERITONEUM

& FITZ-HUGH-CURTIS SYNDROME

INFERTIL-

ITY

ECTOPICPREGNANCY

8/13/2019 10.3 PID - EPI


Management

relief of acute symptoms

eradication of current infection

minimalization of the risk of long term

consequences

antibiotics

surgery (remove or drain a tubo-ovarian

abscess)

8/13/2019 10.3 PID - EPI


Antibiotics

Inpatient treatment

Regimen A: Administer cefoxitin 2 g IV q6h orcefotetan 2 g IV q12h plus doxycycline 100 mgPO/IV q12h.. Continue this regimen for 24hours after the patient remains clinicallyimproved, and then start doxycycline 100 mgPO bid for a total of 14 days. Administerdoxycycline PO when possible because of

pain associated with infusion. Bioavailability issimilar with PO and IV administrations. If tubo-ovarian abscess is present, use clindamycin ormetronidazole with doxycycline for moreeffective anaerobic coverage.

Regimen B: Administer clindamycin 900 mg IVq8h plus gentamicin 2 mg/kg loading dose IVfollowed by a maintenance dose of 1.5 mg/kgq8h. IV therapy may be discontinued 24 hours

after the patient improves clinically, and POtherapy of 100 mg bid of doxycycline shouldbe continued for a total of 14 days. If tubo-ovarian abscess is present, use clindamycin ormetronidazole with doxycycline for moreeffective anaerobic coverage.

Outpatient treatmentRegimen A: Administer ceftriaxone 250 mg IM

once as a single dose plus doxycycline 100 mg

PO bid for 14 days, with or without

metronidazole 500 mg PO bid for 14 days.

Metronidazole can be added if there is

evidence or suspicion for vaginitis or

gynecologic instrumentation in the past 2-3weeks.

Regimen B: Administer cefoxitin 2 g IM once

as a single dose and probenecid 1 g PO

concurrently in a single dose or other single

dose parenteral third-generation cephalosporin

(ceftizoxime or cefotaxime) plus doxycycline

100 mg PO bid for 14 days with or without

metronidazole 500 mg PO bid for 14 days.

Metronidazole can be added if there is

evidence or suspicion of vaginitis or

gynecological instrumentation in the past 2-3

weeks.

10.3 pid - epi

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