Flashcards in 17: Upper GT infections Deck (36)
Endomyometritis occurs most commonly after ?
a delivery or instrumentation of the endometrial cavity
Diagnosis of endomyometritis is made how?
clinically with findings of uterine tenderness, fever, and elevated WBC count.
if unrelated to pregnancy, treat same as PID
if related to pregnancy use broad-spec abx such as IV clindamycin 900 mg q8h and gentamicin loaded with 2 mg/kg IV and then maintained with 1.5 mg/kg IV q8h or IV cephalosporins (cefoxitin 2 g IV q6h)
what % of patients with PID will become infertile?
-because of seriousness of this disease, patients are often hospitalized and treated with IV antibiotics.
Minimal diagnosis criteria for PID consists of ?
pelvic or lower abdominal pain, plus uterine, adnexal, or cervical motion tenderness.
-can lead to TOAs or TOCs
Diagnosis of TOA or TOC is most likely when there is ?
difference betweent TOA and TOC?
Confirmation is usually achieved with ?
an adnexal mass in the setting of PID symptoms.
TOC (complex) are not walled off like the true abscess and are thus more responsive to antimicrobial therapy
an imaging study such as pelvic ultrasound or CT
TOA treatment includes ?
hospitalization and broad-spectrum IV abx:
-cefotetan 2 g IV q12h or cefoxitin 2 g IV q6h plus doxycycline (100 mg PO or IV q12h
-Clindamycin 900 mg q8h plus gentamicin (loading dose of 2 mg/kg, followed by 1.5 mg/kg IV q8h or 5 mg/kg IV q24h) with or without ampicillin (3 g IV q6h)
hospitalized and treated with IV antibiotics and, if necessary, hemodynamic support (fluids, pressors)
risk factors for PID
RPOCs, STIs, intrauterine foreign bodies or growths, instrumentation of the intrauterine cavity
nonwhite and non-Asian ethnicity, multiple partners, recent history of douching, prior history of PID, and cigarette smoking
IUD insertion with current G/C or chlamydial infection
-Mtb a cause in developing countries, may lead to infertility
-s/s: chronic irregular bleeding, discharge, and pelvic pain
-dx: EMB showing plasma cells
chronic endometritis treatment
doxycycline 100mg PO BID x10-14
PID includes ?
any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis
-incidence highest in the 15- to 25-year-old age group
symptoms/sequelae of PID
chronic pelvic pain, increased vaginal discharge, abnormal odor, abnormal bleeding, GI disturbances, and UT symptoms, (fever in 20%), dyspareunia, and pelvic adhesions, infertility, 7-10x risk ectopic pregnancy
Additional diagnostic criteria that supports the diagnosis of PID
fever (>38.3°C), abnormal cervical or vaginal mucopurulent discharge, abundant WBC on saline microscopy of vaginal secretions, elevated ESR, elevated CRP, cervical G/C or Chlamydia infections
definitive diagnosis of PID made by ?
laparoscopy, endometrial biopsy, or pelvic imaging with PID findings.
perihepatitis from the ascending infection resulting in RUQ pain and tenderness and LFT elevations.
N. gonorrhoeae and C. trachomatis;
polymicrobial: such as Bacteroides spp. Gardnerella, Escherichia coli, Haemophilus influenzae, and streptococci.
inpatient PID treatment
broad-spectrum cephalosporin, such as cefoxitin 2 g IV q6h or cefotetan 2 g IV q12h plus doxycycline 100 mg IV or PO q12h
-if allergic to cephs: IV clindamycin and gentamicin (also choice for preggos)
outpatient PID treatment
single dose of ceftriaxone 250 mg IM or cefoxitin 2 g IM plus 1 g of probenecid PO along with doxycycline 100 mg PO BID x14 is used with close follow-up for resolution of symptoms
abdominal and/or pelvic pain (90%) and fever and leukocytosis (60% to 80%). WBC count is usually elevated with a left shift and elevated ESR
if TOA not responsive to abx?
curative therapy for TOA ?
if not responsive to abx, surgical drainage of TOA is recommended.
For bilateral TOAs, often a TAH and bilateral salpingo-oophorectomy (TAHBSO) may be necessary
Nonmenstrual-related TSS has been associated with ?
vaginal infections, vaginal delivery, cesarean section, postpartum endometritis, miscarriage, and laser treatment of condylomata.
high fever (>38.9°C or 102°F), hypotension, diffuse erythematous macular rash, desquamation of the palms and soles 1 to 2 weeks after the acute illness, and multisystem involvement 3+ organ systems, GI (abd pain, V/D), myalgias, mucous membrane hyperemia, increased BUN and creatinine, platelet count less than 100,000, and alteration in consciousness
-Cx may be negative (exotoxin is absorbed)
TSS abx therapy
reduces risk of recurrence
empiric: clindamycin plus vancomycin
MRSA TSS: clindamycin plus vancomycin or linezolid
MSSA TSS: clindamycin plus nafcillin or oxacillin
HIV is initially asymptomatic (latent stage) which can last for ? years
AIDS-related complex includes
lymphadenopathy, night sweats, malaise, diarrhea, weight loss, and unusual recurrent infections such as oral candidiasis, varicella zoster, or herpes simplex
“pre-exposure prophylaxis” among sexually active adults without HIV to reduce their risk of becoming infected
tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC)
zidovudine (AZT), lamivudine (3TC), abacavir, didanosine, and stavudine—act to inhibit reverse transcriptase and interfere with viral replication
(lopinavir, atazanavir, indinavir, saquinavir, ritonavir) interfere with the synthesis of viral particles and have been effective in increasing CD4 counts and decreasing viral load.
With no treatment, approximately ?% of infants born to HIV-infected mothers will become infected with HIV. Increased transmission can be seen with ?
higher viral burden or advanced disease in the mother, ROM, and invasive procedures during labor and delivery that increase neonatal exposure to maternal blood.
how to reduce the risk of perinatal transmission by two-thirds in women
three-part regimen of zidovudine (ZDV) administered during pregnancy and labor and to the newborn
? has been shown to lower transmission rates by roughly two-thirds compared to vaginal delivery in patients on no therapy and particularly without onset of labor or ROM or in the setting of high viral load (>1000 copies/mL)
when to screen preggos for HIV
all pregnant women at their first prenatal visit and again in the third trimester if the woman has specified risk factors for HIV infection
breastfeeding in HIV+ moms?
breastfeeding is contraindicated in HIV-infected woman as virus is found in breast milk and is responsible for HIV transmission to the infant
high incidence of what gyne condition with HIV?
invasive cervical cancer (HPV)
-routine Pap smears at initial evaluation and 6 months later.
-if negative, annual Paps unless documentation of previous HPV infection, squamous intraepithelial lesion, or symptomatic HIV disease, in which case indicates 6-month intervals.