STIs and PID

Question 0

Who gets chlamydia and gonorrhea, mostly?

Answer 0

Adolescents and young adults.

Question 1

What are the 2 main organisms responsible for PID?

Answer 1

Chlamydia and Gonorrhea

Question 2

What’s the best way to test for most STDs?

Answer 2

Nucleic acid tests.

Question 6

What cells of the cervix does N. gonorrhea mainly infect?

Answer 6

Glandular cells

Question 7

What’s more likely to be symptomatic Gonorrhea in men or women?

Answer 7

Gonorrhea in men. Often asymptomatic in women (no itching, burning, etc.)

Question 8

Micro review: N. gonorrhea morphology, staining, culture?

Answer 8

Gram-negative diplococci.

Fastidious growth culture: Low O2, Thayer-Martin or chocolate agar.

Question 9

Contraction rate per exposure for women vs. men?

Answer 9

50% contraction rate for women.

20% contraction rate for men.

Question 10

Do you usually need to give pelvic exams to adolescents?

Answer 10

Nope. Testing for STIs can be done with nucleic acid tests on urine.

Question 11

What’s Chlamydia’s lifestyle like, and how is that related to the pathology it causes?

Answer 11

Intracellular. The pathology is more caused by the immune response to infected tissue.

Question 12

Cells seen in the immune response to Chlamydia?

Answer 12

PMNs
Lymphocytes (mainly T cells)
Plasma cells

Question 13

2 things Chlamydia causes in men?

Answer 13

Non-gonococcal urethritis.

Epididymitis

Question 14

4 things Chlamydia causes in women?

Answer 14

Cervicitis
Endometritis
Salpingitis
Infertility

Question 15

What’s the most frequently reported STI in the US?

Answer 15

Chlamydia

Question 16

What’s the predominant commensal organism in the vaginal mucosa? What do they do?

Answer 16

Lactobacilli. They make peroxides -> acidic pH of vagina.

Question 17

What’s cervical mucus got to do with STIs?

Answer 17

When it’s thick, organisms may have trouble ascending up to the uterus / Fallopian tubes.
(thus, progestins may be somewhat protective against PID)

Question 18

If sperm can get to the peritoneal cavity after sex…

Answer 18

…so can other organisms.

Question 19

3 subdivisions of PID?

Answer 19

Endometritis
Salpingitis
Oophoritis

Question 20

What do normal flora have to do with PID? Implication for treatment of PID?

Answer 20

Chlamydia and Gonorrhea can alter the environment such that these other organisms cause a problem as well.
PID must be treated with broader spectrum ABx than is used for cervicitis.

Question 21

What is the adnexa?

Answer 21

The ovary area of the abdomen, when palpating in a physical exam.

Question 22

What are the 3 minimum criteria for PID diagnosis?

Answer 22

Lower abdominal pain
Adnexal tenderness
Cervical motion tenderness

Question 23

What’s a hydrosalpinx?

Answer 23

Contrast injected into uterine cavity doesn’t make it to the peritoneum because the oviducts are blocked.

Question 24

Several courses that infective salpingitis can follow? (associated conditions?)

Answer 24

Fimbriae remain patent (plicae fusion, ectopic pregnancy)
Spread to ovary (tubo-ovarian abscesses)
Fimbriae become occluded (pyosalpinx -> hydrosalpinx)

Question 25

What’s the pathological definition of PID?

Answer 25

Chronic salpingitis with spread to ovaries / parametrium.

Adhesions common.

Question 26

Do IUDs cause or predispose to PID?

Answer 26

No. An IUD no longer on the market was associated with actinomyces, but that’s dead.

Question 27

Review: Is movement of the ovum / fertilized embryo through the oviduct more about cilia or smooth muscle contraction?

Answer 27

It’s more about the smooth muscle.

Question 28

Where in the oviduct does ectopic pregnancy most commonly occur?

Answer 28

In the ampulla.

Question 29

3 complications of tubal ectopic pregnancy?

Answer 29

Tubal abortion (it can actually be expelled out the fimbriae)
Tubal hemorrhage
Tubal rupture.

Question 30

4 complications of acute PID?

Answer 30

Infertility from tubal scarring
Ectopic pregnancy
Chronic pelvic pain
Abscesses (tubo-ovarian) and peritonitis

Question 31

When you see lower abdominal pain in women of childbearing age you should…

Answer 31

Rule out (ectopic) pregnancy.
Consider PID.

Question 32

Other than age and not using a barrier, what are 2 predisposing factors for infective salpingitis?

Answer 32

Induced abortion

Any manipulation of the cervix (e.g. IUD placement, if cervicitis present, theoretically)