Infectious Disorders of the Uterus

Question 1

What condition is an infection of the uterine endometrium?

Answer 1

Endometritis

Question 2

What generally causes endometritis?

Answer 2

C-Section

or Microbes coming from vagina, GI tract…

Question 3

What is the condition called when endometritis invades the myometrium?

Answer 3

endomyometritis

Question 4

When will a patient generally present with endometritis?

Answer 4

after a surgical or clinical procedure
-C-section
Rarely dilation and evacuation (D&E), dilation and curettage (D&C), or others

Question 5

Is endometritis usually caused by monomicrobial or polymicrobial infections?

Answer 5

Polymicrobial

Question 6

Is endometritis usually acute or chronic?

Answer 6

Usually acute and severe

Can be chronic

Question 7

How is endometritis diagnosed?

Answer 7

uterine tenderness
fever over 100.4 (38C) on 2-3 day postpartum
elevated WBC count - neutrophils
recent hx of procedure
possibly foul smelling discharge

Question 8

What is the treatment of endometritis?

Answer 8

Postpartum: hospitalization with IV antibiotics (clinda or gent until 24 hr afebrile)
Not recently pregnant: follow PID protocol

Question 9

How does the chronic form of endometritis usually present?

Answer 9

Can be asymptomatic
Chronic irregular bleeding, discharge, pelvic pain
NO fever

Question 10

How is chronic endometritis diagnosed?

Answer 10

endometrial biopsy

Question 11

How is chronic endometritis treated?

Answer 11

Doxy 100mg PO bid x 10-14 days

Question 12

What is the general term for bacterial infection of the female pelvic organs?

Answer 12

Pelvic Inflammatory Disease

Question 13

What is the term for a bacterial infection of the cervix?

Answer 13

Cervicitis

Question 14

What is the term for a bacterial infection of the fallopian tubes?

Answer 14

Salpingitis

Question 15

What are the principle organisms that cause Pelvic Inflammatory Disease?

Answer 15

Polymicrobial, but…
N. gonorrhoeae
C. trachomatis

Question 16

What describes a common PID patient?

Answer 16

Young
Sexually active
Multiple partners

Question 17

What are the complications of PID?

Answer 17

Infertility
Ectopic pregnancy
Pelvic adhesions
Chronic pelvic pain

Question 18

What are the clinical manifestations of PID?

Answer 18

Abdominal or pelvic/adnexal pain (bimanual exam)
Purulent cervical discharge
Cervical motion tenderness (CMT)
Chills and fever
Abnormal bleeding

Question 19

Right upper quadrant pain with PID may indicate what?

Answer 19

Spread of the infection to the liver

AKA Fitzhugh-Curtis syndrome

Question 20

What are the chances of infertility with PID?

Answer 20

1 episode = 12% chance
2 episodes = 20% chance
3 episodes = 40% chance

Question 21

How is a bimanual exam performed?

Answer 21

2 fingers in the vagina, pushing up on the cervix

The other hand pushing down on the abdomen

Question 22

What is the minimum CDC diagnostic criteria for PID?

Answer 22

Hx of pelvic or low abdominal pain in sexually active young woman.
PE that reveals uterine or adnexal tenderness or CMT.
No competing diagnosis (UTI, ectopic, apendicitis…)

Question 23

What diagnostic tests are helpful to diagnose PID?

Answer 23

Saline microscopy (wet prep) - looking for WBCs
Endocervical culture
(optional - Erythrocyte sed rate, C-reactive protein)

Question 24

If diagnosis of PID remains uncertain, what other tests can be done?

Answer 24

Endometrial biopsy for endometritis
Transvaginal sonography or MRI
Culdocentesis
Laparoscopy

Question 25

What is the treatment of PID?

Answer 25

Treat empirically (do not delay while waiting for labs)
Remove IUD if one exists
Outpatient: ceftriaxone 250mg IM, plus doxy 100 mg po bid x 14days (may add metro 500 mg po bid x 14 days)
Treat partner
Possible hospitalization for IV antibiotics

Question 26

Why might you need to hospitalize a PID patient?

Answer 26

If they have:
HIV
Tubo-ovarian abscess present
Pregnant
Did not respond to outpatient therapy
Cannot follow outpatient therapy (homeless, cog issues)
Severe illness, N/V or high fever
Other surgical emergency not ruled out (appendicitis)

Question 27

What is the term for an abscess-like complex that involves the fallopian tube and ovary, a complication arising from persistent PID?

Answer 27

Tubo-ovarian abscess

Question 28

How will a patient with tubo-ovarian abscess present?

Answer 28

With PID plus an adnexal or rectouterine pouch mass or fullness, and usually has a fever and leukocytosis. (bimanual exam essential)

Question 29

What is the preferred diagnostic test for Tubo-ovarian abscess?

Answer 29

Ultrasound

bimanual exam would be painful and feel like ovarian mass

Question 30

What is the treatment for tubo-ovarian abscess?

Answer 30

Admission to the hospital for IV antibiotics and possible surgical excision