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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.

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PELVIC INFECTIONS & URINARY TRACT INFECTION

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  1. PELVIC INFECTIONS & URINARY TRACT INFECTION DR. AKINWUNMI L. AKINWUNTAN MBBS (Ibadan), MHS Pop. & RH (Ibadan), FMCOG (Nig), FWACS OBSTETRICIAN & GYNAECOLOGIST

  2. 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

  3. Acute Salpingitis

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Anaerobic • Bacteroides sp. • Peptostreptococcus sp. • Clostridium bifermentans • Fusobacterium sp. Viruses • Herpes simplex • Echovirus • Coxsackie

  10. 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

  11. 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

  12. 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

  13. Polyathralgia • Tenosynovitis • Dermatitis • Conjunctivitis Opthalmia Neonatorum

  14. 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

  15. DIAGNOSIS • Discharge – Urethral, Cervical, Anal, Pharynx • Thayer-Martins Media • Gram Negative Diplococci in leucocytes • ELISA • Nucleic Acid Amplification Test (NAATs)

  16. 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

  17. CLINICAL PRESENTATION • ASYMPTOMATIC • FEVER • ABNORMAL VAGINAL DISCHARGE • LOWER ABDOMINAL PAIN • PAINFUL INTERCOURSE • IRREGULAR MENSTRUAL BLEEDING • PAINFUL MENSTRUATION • CERVICAL MOTION TENDERNESS • COMPLICATION ie Infertility

  18. DIAGNOSIS • Based solely on lab test • Cell Culture isolation: sensitivity= 70-90% • Complement Fixation Methods • Immunofluorescence • DNA Probe

  19. Genital Ulcer Disease Syphilis Chancroid Herpes Simplex

  20. Genital herpes vesicles

  21. Typical vaginal discharge caused by trichomoniasis

  22. “Strawberry cervix” due to T. vaginalis

  23. 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

  24. Essential Steps In STI Care Management* Syndrome Assessment Contact tracing Compliance Confidentiality Condom use Counseling (diagnostic tools) 5Cs Diagnosis Treatment (screening tests) Risk Assessment

  25. ANTIBIOTIC Rx • CEPHALOSPORINS • Cefuroxime • Ceftriaxone • Cefpodoxime eg Orelox • MACROLIDES • Azithromycin • TETRACYCLINS • Doxycycline • FLUOROQUINOLONES • Ciprofloxacin, Levofloxacin, Ofloxacin

  26. URINARY TRACT INFECTION • A urinary tract infection (UTI) is a bacterial inflammation in the urinary tract • Urethritis - Urethra • Cystitis – Bladder • Pyelonephritis - Kidneys

  27. Risk factors • Women • Anatomy • Sexual intercourse • Pregnancy • Catheterization • Bladder/Kidney stones • Immunosuppression • Stroke/Bedridden • Family history • Diabetes Mellitus

  28. CAUSES • E. Coli - 80 – 85% • Klebsiella • Pseudomonas • Proteus • Enterobacter • Rarely – Viruses and Fungi

  29. 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

  30. SYMPTOM & SIGNS….. • In the Elder Post-menopausal • Incontinence • Altered sensorium • Fatigue • Sepsis • Plus earlier symptoms

  31. 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

  32. 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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