23 - Upper Genital Tract Infections

Endometritis

Infection of the endometrium and occurs once an infection ascends

Endomyometritis

Ascending infection that invades the myometrium

Pelvic Inflammatory Disease (PID)

Infection in the upper genital tract not associated with pregnancy or intraperitoneal pelvic operations

· Uterine tenderness or

· Adnexal tenderness or

· Cervical motion tenderness

Minimum criteria for PID

· Oral temperature >38C

· Abnormal cervical or vaginal discharge(mucopurulent)

· Presence of abundant WBCs on microscopy of vaginal secretions

· Elevated ESR

· Elevated CRP

· Laboratory documentation of cervical infection with N. gonorrhea or C. trachomatis

Additional criteria for PID

· Histopathologic evidence of endometritis on endometrial biopsy

· Transvaginal sonography or MRI showing thickened fluid-filled tubes, with or without free pelvic fluid or tubo-ovarian complex

· Laparoscopic abnormalities consistent with PID

Definitive criteria for PID

· Ceftriaxone + doxycycline + metronidazole OR

· Ceftotetan + doxycycline OR

· Cefoxicitin + doxycycline

Recommended parenteral regimens for PID

· Ampicillin/sulbactam + doxycycline OR

· Clindamycin + gentamicin

Alternative parenteral regimens for PID

· Ceftriaxone + doxycycline + metronidazole OR

· Cefoxitin AND probenecid + doxycycline + metronidazole OR

· Ceftizoxime or cefotaxime + doxycycline + metronidazole

IM or oral treatment regimens for PID

72 hrs

How many hours after IM/oral therapy should PID management be stepped up?

3 months

How many months should retesting be done in PID patients who underwent treatment?

Tubo-ovarian abscess (pyosalpinx)

Sequelae of persistent PID, characterized by an adnexal solid/cystic mass

Tubo-ovarian complex (TOC)

Sequelae of PID that is not walled off like a true abscess and thus is more responsive to antimicrobial theral