Gyn Infections II
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| Secondary complications of PID | Tubo-ovarian abscess, Fitz-Hugh-Curtis Syndrome (perihepatitis)
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| Clinical presentation of Bartholin's gland abscess | vulvar pain and swelling for 2 days, walking and sitting discomfort, generally unilateral, tender, fluctuant, erythematous swelling at 5:00 or 7:00, may be pointing/peaking
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| Causes of Bartholin's gland Abscess | GC is a frequent cause. Also strep, E. coli, Chlamydia, anaerobes. Bilateral infections may be associated with GC
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| Tx of Bartholin's gland abscess | If not pointing, abx may be successful. I&D and placement of Word Catheter (for 1-2 wks), Marsupialization (removal of gland), needs to remain open to avoid recurrence
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| Only way to guarantee that a Bartholin's gland abscess will not reoccur | Marsupialization
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| Which Staph strain prodcues exotoxins? | S. aureus. Causes 3 syndromes: Food poisoning, scalded skin syndrome, TSS (50% of cases are menstrual, Host antibody response is key: flu-like sx, need IV abx, can tx presumptively esp if flu-like sx)
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| What ingredient did early tampons contain that was associated with the onset of TSS in the late 1970s? | Rayon
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| Clinical Presenation of TSS | rapid onset in healthy woman perimenstrually, fever, hypotension, skin manifestations,CDC def: T>38.9C, hypotension, Diffuse erythroderma, desquamation, involvement of at least 3 organ systems
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| Skin Manifestations of TSS | Erythroderma of skin and mucous membranes, diffuse red sun-burn like rash, skin peels, involves palms and soles, conjunctival-scleral hemorrhage, later pruritic maculopapular rash, desquamation
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| Tx of TSS | Supportive (hypotension), remove FB (tampon, sponge), Combination Abx Tx (EBM not clear),
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| PID Definition | PID is a common condition in which microorganisms spread from the lower genital tract infect and inflame upper genital tract structures including the endometrium, tubes, ovaries and peritoneum. can affect fertility, ectopic pregnancy, chronic pelvic pain
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| Sx of PID | Abdominal pain, dyspareunia, possibly fever/chills, Possibly RUQ pain
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| Signs of PID | Peritoneal irritation makes movement uncomfortable, Rebound pain, "PID shuffle", After onset or cessation of menses
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| Hallmark of PID | Cervical motion tenderness
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| CDC minimum criteria for PID | Lower abdominal tenderness, Adnexal tenderness, Cervical Motion tenderness (if these 3 exist with no other cause, tx empirically)
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| CDC additional criteria for PID | Elevated oral Temp (>101), Abnormal cervical or vaginal discharge, Elevated ESR, Elevated CRP, Positive GC or Chlamydia, Possible elevated WBC
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| Gold standard for diagnosing PID | Laparascopy. However, Dx of PID is inaccurate due to low sens and specificity.
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| PID on PE | Mucopurulent Cervicitis (mucopus), Cervical motion tenderness, adnexal tenderness
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| PID differential diagnosis | Appendicitis, Endometriosis, Corpus luteum leaking/bleeding, Ectopic pregnancy, Adhesions
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| PID note | always r/o pregnancy! Always consider other causes of acute abdomen
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| Hospitalize PID if | nulliparity, adolescents, non-compliant, pregnant, tx failure, HIV, immunosuppression, Unable to tolerate oral regimen, Tubo-ovarian abscesses (TOA), severe peritonitis, uncertain Dx
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| Risk factors for PID | Sex during menses, >1 male partner in last 30 days, Partiy>0, lack of BCM, Douching, Early sexual debut, prior hx of PID, STD, recurrent chlamydia, 12-25 yo, current smoker, <19yo, Cocaine use
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| Tx of PID | CDC guidelines for inpatient and outpatient, treat the partners
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| Notes on Tubo-ovarian abscesses (TOA) | Textbooks say bilateral, but may be unilateral. Often requires surgery. Rupture and septic shock that ensues is life threatening
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| "Violin String" adhesions between the liver and the parietal peritoneum | Fitz-Hugh-Curtis Syndrome. May be caused by GC or Chlamydia. RUQ pain may be prominent sx, especially in young women
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| IUD-PID connection occurs only | at time of insertion
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| PID Notes: | polymicrobial, anaerobes important. Endometritis is a subtler picture, especially in women s/p tubal ligation. Also remember Upper Genital Tract Infection. Think about immunosuppression when no improvement. TREAT THE PARTNER
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