Patho/Phys: Exam 3 STIs (Ch. 34)

pelvic inflammatory disease

• infection of the female reproductive system

• very commonly affects fallopian and ovaries

• may or may not be sexually transmitted

etiology of PID

multiple types of bacteria and other microorganisms

prevalence of PID

about 4.1% of sexually active women in the US have been treated for PID in their lifetime

predisposing factors of PID

• presence of STI

• younger than 24

• multiple sex partners

• prior episodes of vaginitis and cervicitis

causes of PID

• N. gonorrhea

• C. trachomatis

pathophysiology of PID

1. microbes ascend through uterus into fallopian tubes (salpingitis)

2. early stage of inflammation promotes invasion of bacteria into mucosa

3. tubal walls become edematous

4. lumen is filled with purulent exudate

5. tubes becomes obstructed and prevent drainage into uterus

6. exudate drips from fimbriae onto ovary and surrounding tissue

7. peritoneal membrane cannot contain infection

what complications may occur in PID

• peritonitis

• abscesses form and need surgical drainage to prevent life-threatening infection

• septicemia from systemic infection if it spreads too much and causes septic shock and even death

• adhesions and strictures may affect tubes and ovaries

• could cause infertility, ectopic pregnancy, or colon problems

clinical manifestations of PID

• lower abdominal pain increasing in intensity = caused by inflammatory process

• continual pain that intensifies with ambulation and worsens over time as scar tissue and adhesions form = irritation of inflamed tissue

• pelvic exam showing purulent discharge from cervical os- opening in the center of ectocervix = inflammatory and infectious process

• fever and chills = infection from vaginitis and cervicitis ascending into uterus and fallopian tubes and out to peritoneal cavity

causes of genital herpes

• HSV-2: herpes simplex virus type 2

• HSV-1 oral sex or autoinoculation

• transmission of either strain of HSV through direct contact with skin or mucous membranes when an infected individual is symptomatic

• HSV-1 and HSV-2 can be transmitted without any symptoms being apparent = asymptomatic shedding

  • impossible to predict when this will occur

prevalence of genital herpes

affects more than 24 million people in the US

acute stage in male genital herpes

• causes tingling and burning sensation in inoculation site before lesions appear

• then, lesions usually on penis, scrotum, or urethra

• blister-type vesicle loaded with herpes viruses

• lesion is surrounded by erythema

• vesicle ruptures after sexual days, causing painful ulcerated area with watery exudate

• crust forms over the ulcer and heals spontaneously in 3-4 weeks

dormant stage in male genital herpes

• HS migrates along dermatome to dorsal sacral root ganglion near infection site

• virus dormant until reactivated by stress or other infections

• migrates back to mucosa or skin

• enters host for replication

• new vesicle is formed

pathophysiology in female genital herpes

• virus causes herpetic lesions located on cervix, vulva, or urethra

• risk factor for cervical cancer

• same cycle of lesion outbreaks and dormancy as in males

• active vaginal or cervical lesions can cause transmission to a neonate during vaginal delivery

• frequently leading to severe central nervous system damage or death in a newborn

• delivery via C-section is recommended

clinical manifestations in male genital herpes

• due to generalized systemic infection: fever, headache, lymphadenopathy

• due to localized infection: vesicular herpetic lesions

clinical manifestations in females

• systemic infectious signs in acute stage: fever, headache, lymphadenopathy

• reddened area surrounds fluid-filled vesicles

• herpetic cells increase the risk for cervical cancer

risk for neonates for females with genital herpes

• cross contamination from active lesions in vagina or cervix during vaginal childbirth can cause death or severe central nervous system damage

• can also affect skin, eyes, mouth

• delivery by C-section recommended