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Chlamydial Pelvic Inflammatory Disease

Pelvic Inflammatory Disease Due to Chlamydia Trachomatis


Presentation

  • Abstract Two cases of chlamydial pelvic inflammatory disease (PID) are presented. Each was clinically assessed and followed by laboratory methods now available to practitioners.[ncbi.nlm.nih.gov]
  • Abstract Pelvic inflammatory disease (PID) is the most important complication present in the female lower genital tract, causing major medical, social and economic problems.[ncbi.nlm.nih.gov]
  • Non-gonococcal and non-chlamydial PID present as similar to gonococcal disease.[news-medical.net]
  • In a significant number of women with pelvic inflammatory disease both bacteria may be present at that same time. However, it is not uncommon for other pathogenic bacteria to be present as well.[virtualmedstudent.com]
  • Classic Presentation Women typically present with bilateral lower abdominal pain, purulent vaginal discharge, or less frequently with abnormal vaginal bleeding.[cdemcurriculum.com]
Falling
  • Modes of spread of infection to the fall opiantubes. Acta Pathol Microbiol Scand [B] 88: 107 Google Scholar 39.[link.springer.com]
  • Every year over a million women in the United States alone fall into an episode of PID. As a consequence, more than 100,000 of them face infertility every year. Apart from that, PID is responsible for a large amount of ectopic pregnancies.[std-gov.org]
Malaise
  • Patients may also present with fever, nausea, vomiting and general malaise, but this is variable and may range from minimally symptomatic to toxic appearing.[cdemcurriculum.com]
Unsafe Sexual Practices
  • It is mostly acquired through unsafe sexual practices and is one of the most serious consequences of sexually transmitted diseases (STD).[drelsa.ae]
Abdominal Pain
  • These patients presented with vaginal discharge and chronic abdominal pain. They initially had positive chlamydia cultures which became negative after treatment with tetracycline.[ncbi.nlm.nih.gov]
  • In practice, when a woman of a generative age presents with pelvic or lower abdominal pain, PID must be taken into account in the differential diagnosis.[news-medical.net]
  • Additional information on symptoms, other evidence of infection, or indications of severe disease included the following: abdominal pain (noted for 13 women); the presence of two of three symptoms (abdominal pain, cervical-motion or uterine tenderness[nejm.org]
  • Symptoms in women include Abnormal vaginal discharge, which may have a strong smell A burning sensation when urinating Pain during intercourse If the infection spreads, you might get lower abdominal pain, pain during sex, nausea, or fever.[icdlist.com]
Chronic Abdominal Pain
  • These patients presented with vaginal discharge and chronic abdominal pain. They initially had positive chlamydia cultures which became negative after treatment with tetracycline.[ncbi.nlm.nih.gov]
Vaginal Discharge
  • These patients presented with vaginal discharge and chronic abdominal pain. They initially had positive chlamydia cultures which became negative after treatment with tetracycline.[ncbi.nlm.nih.gov]
  • Others have pain in the lower abdomen, fever, smelly vaginal discharge, irregular bleeding, and pain during intercourse or urination. Doctors diagnose PID with a physical exam, lab tests, and imaging tests. Antibiotics can cure PID.[icdlist.com]
  • To find out if someone has PID, health care providers: ask about sexual activity ask about symptoms do a physical exam, including a pelvic exam test urine (pee) and vaginal discharge for STDs Sometimes more testing is needed.[kidshealth.org]
  • Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with a sexually transmitted infection (STI). If these signs and symptoms occur, stop having sex and see your doctor soon.[mayoclinic.org]
  • Cervical / vaginal discharge Irregular vaginal bleeding Heavy blood loss suggests endometritis Fever (About 1/3 of patients) Cervicitis The cervix will appear red and will bleed easily OFTEN ASYMPTOMATIC![almostadoctor.co.uk]
Pelvic Pain
  • This can lead to infertility, ectopic pregnancy, pelvic pain, abscesses, and other serious problems. PID is the most common preventable cause of infertility in the United States.[icdlist.com]
  • PID can also cause long term lower abdominal or pelvic pain. Tests There is no test that can say for sure whether a women has PID or not.[nt.gov.au]
  • Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that might last for months or years. Scarring in your fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation. Tubo-ovarian abscess.[mayoclinic.org]
  • SLIDESHOW Pelvic Pain: What's Causing Your Pelvic Pain? See Slideshow Pelvic Inflammatory Disease (PID) Center Medically Reviewed on 8/16/2018 References SOURCE: "Pelvic Inflammatory Disease." womenshealth.gov. Updated August 31, 2015.[medicinenet.com]
  • And early presentation for the diagnosis and treatment of pelvic pain should be a key message of all sexual health promotion programs.[theconversation.com]
Salpingitis
  • Ossler S, Persson K (1982) Epidemiologie and serodiagnostic aspects of chlamydial salpingitis. Obstet Gynecol 59: 206 Google Scholar 18. Paavonen J, Saikku P, Vesterinen E, Aho K(1979) Chlamydia trachomatis in acute salpingitis.[link.springer.com]
  • (catarrhal) (fallopian tube) (nodular) (pseudofollicular) (purulent) (septic) N70.91 ICD-10-CM Diagnosis Code N70.91 Salpingitis, unspecified 2016 2017 2018 2019 Billable/Specific Code Female Dx chlamydial A56.11 ICD-10-CM Codes Adjacent To A56.11 A54.89[icd10data.com]
  • - A56.11 - Disease, diseased - See Also: Syndrome; - pelvis, pelvic - inflammatory (female) - N73.9 - chlamydial - A56.11 - Endometritis (decidual) (nonspecific) (purulent) (senile) (atrophic) (suppurative) - N71.9 - chlamydial - A56.11 - Salpingitis[icdlist.com]
  • Salpingitis with endometritis and oophoritis, with or without peritonitis, is often called salpingitis even though other structures are involved. Pus may collect in the tubes (pyosalpinx), and an abscess may form (tubo-ovarian abscess).[msdmanuals.com]
  • N70.0 Acute salpingitis and oophoritis N70.1 Chronic salpingitis and oophoritis Hydrosalpinx N70.9 Salpingitis and oophoritis, unspecified N71 Inflammatory disease of uterus, except cervix Includes: endo(myo)metritis metritis myometritis pyometra uterine[apps.who.int]
Dyspareunia
  • Retrospective analysis showed that 43 of the women were given outpatient treatment for acute pelvic inflammatory disease because they had low abdominal pain, deep dyspareunia, or unusual vaginal bleeding, or all of these, for less than 2 months in association[annals.org]
  • The affected women may also suffer from dyspareunia ( i.e. recurrent or persistent genital pain during or after sexual intercourse), backache and infertility.[news-medical.net]
  • More common presentations include acute pelvic pain (of variable intensity), cervical motion tenderness, vaginal discharge, fever, dyspareunia, and leukocytosis. Right upper quadrant pain from perihepatitis in Fitz-Hugh-Curtis syndrome is possible.[radiopaedia.org]
  • Other causes of dyspareunia - eg, endometriosis. Investigations Pregnancy test (pregnant women with PID should be admitted; ectopic pregnancy may be confused with PID).[patient.info]
  • Infection and the resulting inflammation that occurs can make having sex painful (ie: "dyspareunia") and can make urinating painful (ie: "dysuria"). In addition, abnormal vaginal odors and discharges are also possible.[virtualmedstudent.com]
Cervical Motion Tenderness
  • More common presentations include acute pelvic pain (of variable intensity), cervical motion tenderness, vaginal discharge, fever, dyspareunia, and leukocytosis. Right upper quadrant pain from perihepatitis in Fitz-Hugh-Curtis syndrome is possible.[radiopaedia.org]
  • motion tenderness and adnexal or uterine tenderness.[sti.guidelines.org.au]
  • On pelvic examination PID is very likely if there is purulent endocervical discharge, cervical motion tenderness (chandelier sign), and adnexal tenderness with bimanual examination. Rectovaginal examination can further support these findings.[pedclerk.bsd.uchicago.edu]
  • The Centers for Disease Control and Prevention (CDC) suggest that the presence of cervical motion tenderness or tenderness of the uterus or adnexa on exam are the minimum diagnostic criteria.[clinicaladvisor.com]
  • This minimum criterion includes history of lower abdominal or pelvic pain coupled with adnexal, uterine or cervical motion tenderness on exam, in a patient at risk for STDs with no other discernible cause for the illness identified.[cdemcurriculum.com]

Workup

Chlamydia Trachomatis
  • Johannisson G, Löwhagen G-B, Nilsson S (1982) Chlamydia trachomatis and urethritis in men. In: Mårdh P-A, Moller BR, Paavonen J (eds) Chlamydia trachomatis in genital and related infections.[link.springer.com]
  • […] of cervix due to Chlamydia trachomatis Infection of peritoneum due to Chlamydia trachomatis Pelvic inflammation with female sterility due to Chlamydia trachomatis PID with female sterility due to Chlamydia trachomatis Index to Diseases and Injuries References[icdlist.com]
  • Article Figures/Media 29 References 402 Citing Articles Letters Abstract Background Chlamydia trachomatis is a frequent cause of pelvic inflammatory disease.[nejm.org]
  • Abstract: Pelvic inflammatory disease (PID) results most frequently from the ascent of sexually transmitted Chlamydia trachomatis or Neisseria gonorrhoeae infections from the cervix to the upper genital tract.[popline.org]
  • , Catherine O'Connell, Uma Nagarajan, Harold Wiesenfeld, Sharon Hillier and Toni Darville J Immunol May 1, 2014, 192 (1 Supplement) 185.4; Abstract Processes driving development of immune pathology after Chlamydia trachomatis infection are poorly understood[jimmunol.org]

Treatment

  • They initially had positive chlamydia cultures which became negative after treatment with tetracycline. Their chlamydia titers increased throughout the course of their disease and treatment.[ncbi.nlm.nih.gov]
  • Since PID is the most significant consequence of sexually transmitted bacterial infections, treatments to prevent its long-term sequelae are essential.[popline.org]
  • Since PID is the most important consequence of sexually transmitted bacterial infections, it is also imperative to develop better treatments to prevent the long-term sequelae of this disease.[ncbi.nlm.nih.gov]
  • Early treatment is important. Waiting too long increases the risk of infertility.[icdlist.com]
  • Allergy to principal treatment choice Seek specialist advice.[sti.guidelines.org.au]

Prognosis

  • […] become prominent due to infection draining in to lymphatics along the course of the gonadal veins MRI May show an ill-defined adnexal mass containing fluid with various signal intensities: T1 C (Gd): wall and surrounding tissues may enhance Treatment and prognosis[radiopaedia.org]
  • Prognosis and complications Recurrence rates amongst patients with PID is high. One study of low income AA age 19 showed recurrence rates of 25 and 20 percent, respectively, at 84 months post-treatment.[pedclerk.bsd.uchicago.edu]
  • Prognosis Getting prompt treatment and follow-up care can cure pelvic inflammatory disease and keep it from causing further problems.[drugs.com]
  • Prognosis and Patient Counseling. Women with cervicitis or PID should abstain from sexual intercourse until they have completed antibiotic therapy, their partners have been treated and both the patient and her partner are asymptomatic.[clinicaladvisor.com]

Etiology

  • This article reviews the available literature on the etiology of PID, its clinical manifestations, the pathogenesis and host response to C. trachomatis in PID, diagnosis, PID management, PID-related morbidity, and prevention.[popline.org]
  • Etiological studies with emphasis on chlamydial infection. Obstet Gynecol 59: 550 PubMed Google Scholar 14.[link.springer.com]
  • If NAAT is negative, or if another cause is more likely, there are other possible etiologies of cervicitis.[clinicaladvisor.com]
  • Acute pelvic inflammatory disease: etiology, risk factors and pathogenesis. Clin Obstet Gynecol 1976 Mar;19(1):147-69. (2) McCormack MW. Pelvic Inflammatory Disease. N Engl J Med 1994; 330:115-119 (3) Centers for Disease Control and Prevention.[virtualmedstudent.com]

Epidemiology

  • Sexually transmitted diseases, pelvic inflammatory disease, and infertility: an epidemiologic update. Epidemiol Rev 1990 ;12: 199 - 220 3. Westrom L, Wolner-Hanssen P. Pathogenesis of pelvic inflammatory disease. Genitourin Med 1993 ;69: 9 - 17 4.[nejm.org]
  • Eschenbach DA (1980) Epidemiology and diagnosis of acute pelvic inflammatory disease. Obstet Gynecol Suppl 55: 142 Google Scholar 13. Gjønnaess H, Dalaker K, Ånestad G, Mårdh P-A, Kvile G, Bergan T (1982) Pelvic inflammatory disease.[link.springer.com]
  • Epidemiology Every year in the United States PID accounts for 2.5 million outpatient visits, 200,000 hospitalizations, and 100,000 surgical procedures.[pedclerk.bsd.uchicago.edu]
  • Epidemiology The exact prevalence of PID is unknown as it is under-diagnosed and it is also often asymptomatic [ 1 ]. The rate of definite PID diagnosis in primary care is around 280/100,000 person-years [ 2 ].[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Symptoms manifesting from these responses include an oral temperature 38.3 C (101 F), elevated erythrocyte sedimentation rate or C-reactive protein, or presence of white blood cells on microscopy of vaginal secretions. 1,2,11 Pathophysiology and Diagnosis[uspharmacist.com]

Prevention

  • Recent technological advances should further enhance efforts to prevent chlamydial infection and PID.[ncbi.nlm.nih.gov]
  • Since PID is the most significant consequence of sexually transmitted bacterial infections, treatments to prevent its long-term sequelae are essential.[popline.org]
  • Can I prevent chlamydia? The only sure way to prevent chlamydia is to not have vaginal, anal, or oral sex. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading chlamydia.[icdlist.com]
  • Several pieces of the prevention puzzle have been put in place in recent decades. The prevention of sexually transmitted infections that can cause pelvic inflammatory disease has received deservedly increased attention.[nejm.org]
  • Back to top Prevention STIs, mainly untreated chlamydia or gonorrhea, is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STIs or by getting early treatment if they do get an STI.[pamf.org]

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