31 Jul Gynecological Infections

• Sexually transmitted disease.
  • Pelvic inflammatory disease (PID):
    • infectious and inflammatory: affects the upper part of the female reproductive tract: ovaries, uterus, fallopian tubes, and other pelvic structures.
    • can include the liver (in which it is called Fitz-Hugh-Curtis).
    • In most cases, it is sexually transmitted.
    • Associated with multiple sexual partners, frequent vaginal douching, having dilatation and curettage, hysteroscopy, or endometrial biopsy.
    • The use of an intrauterine device increases risk.
    • Vaginal discharge that is purulent in nature
    • Lower abdominal or pelvic pain, cervical motion tenderness, adnexal and uterine tenderness, and a fever of greater than 101 degrees Fahrenheit.
    • Rebound tenderness in the abdomen and foul-smelling vaginal discharge.
    • Right upper quadrant abdominal pain and tenderness: R/O Fitz-Hugh-Curtis syndrome.
    • Elevated ESR and CRP.
    • Organisms: Cervical or vaginal cultures: Neisseria gonorrhea and Chlamydia trachomatis: both sexually transmitted.
    • Facilitate involvement of other types of bacteria, particularly anaerobic bacteria.
    • Viruses: Cytomegalovirus and herpes simplex type 2 can be involved in PID.
    • Hemophilus influenzae, Gardnerella, Bacteroides and Peptococcus could be part of the polymicrobial agents.
    • Diagnosis: Laparoscopy, Ultrasound, CT, or MRI.
    • Complications are tube-related infertility, ectopic pregnancy, and chronic pelvic pain. Tubo-ovarian abscess is rare: life-threatening on rupture.
    • Treatment: IUD removal (if present), Aggressive antibiotic use: At some stage: laparotomy for lysis of adhesions, irrigation of the pelvis, and drainage of abscesses.
  • Unrelated to a sexually transmitted disease.
    • Bacterial vaginosis (BV):
    • lower reproductive infection that does not involve the uterus, fallopian tubes, or ovaries.
    • Nonspecific vaginitis.
    • Lack of a real inflammatory response
    • Gardnerella vaginalis is the main bacterial species. Lactobacillus species, or Mobiluncus species.
    • Associated with recently used antibiotics, decreased levels of estrogen, or frequent use of vaginal douches.
    • Fishy vaginal odor increased vaginal discharge, irritation of the vulva and pain with urination or intercourse.
    • Absence of pelvic or abdominal pain and a normal pelvic examination.
    • A pH of the discharge of greater than 4.5.
    • Polymicrobial in nature: Facultative anaerobe: No relation to sexual activity.
    • Disruption in the normal vaginal flora triggers the chance of BV.
    • Treatment: Antibiotic coverage for Gardnerella vaginalis, Douching, over-the-counter vaginal cleansing products, and bubble baths should be avoided, IUD removal (if inserted). Hypoallergenic soap to wash the genitalia.
    • Complications: Endometritis, chorioamnionitis (in pregnancy), cervicitis, and possibly PID. Rarely: Bacteremia.