Neisseria Gonorrhea

Strong association with

chlamydia
Treat both chlamydia and
gonorrhea

Genital Tract Mycoplasma

-

No tubal damage

Risk Factors:
Cervical ectopy- cervix is in the
transformation zone
Transformation zone
squamocolumnar junction
Oral Contraceptives
-

Regular pap smear and

examination are advised

Sexual Factors
-

High frequency of intercourse

more than 3x a week
E. coli

Criteria:
-

Chlamydia gives more

destruction
The cilia will get
eliminated;flattened; ectopic
pregnancy and salphingitis

Endocervical canal - female

Urethra male

Cervical Discharge of patient usually

purulent; Q TIP TEST green or yellow
= treat as soon as possible
Subclinical PID
-

Profuse menstruation; pain

Importance: History Taking

Ask: Did you have many sexual
intercourse during menstruation?
Overt Acute PID
-

Previous PID
-

Alters the microorganism

inhabiting the vagina
May initiate the endometritis
Mechanical spore moving the
bacteria

Harder to treat
If vomiting, cannot prescribe
oral antibiotics
Gold Standard Laparoscopy
Most specific Endometrial
biopsy

3 absolute criteria:
-

Lower abdominal pain

Adnexal tenderness

PID Diagnostics:
Douche

Small apparatus with elongated

tip and flush with betadine or
lactic acid

Sausage appearance
Pyosalphinx
Hydrosalphinx separate pus
from water; more chronic
infection
Hairlike projections cilia

Ovum (ovulate) -> fimbriae (important

structure in the fallopian tube,
function: ovum pick-up, ovum is
mobile -> fimbriae will catch it -> if
reaches distal 1/3 of fallopian tube ->

Criteria for hospitalization

-

Life Span of egg cells: 1-2 hours

Next month: same procedure
If PID is present, more leukocytes are
present -> cilia will become denuted
or flat or sometimes totally disappears

Ultrasound tuboovarian
abscesses
Cogwheel sign Pyosalphinx thick walled tube;
wheel shaped

Surgical emergency cannot be

excluded
Pregnant
immunocompromised state
Severe illness n/v
Tuboovarian abscess

Medication
-

PID Diagnostics

Treat partner husband

(possible reinfection

Advise patient to come back

after 42-72 hours
Even if suspected, treat patient

REGIMEN B Recommended treatment

regiments for OPD

Bacterial Vaginosis ; promotes entry

of bacteria; if foul smelling
Metronidazole is given

Differential Diagnosis: (lalabas sa

exam!)
-

Acute appendicitis
Endometriosis
Torsion/ rupture adnexal mass
Ectopic pregnancy

Treatment
-

Therapeutic goal
Quinolone high incidence
resistance to Neisseria
gonorrhea
For example, patient is in
severe pain give antibiotics for
24 hours -> shift to oral meds
Remove IUD IUD serves as a
weak

If Pregnant Azithromycin 500 mg per

tablet, 2 tablets single dose (Sabay
iinumin)
-

Do not give Doxycycline if

pregnant
The patient may have
tuboovarian abscesses

Dysuria BURNING SENSATION

(GONORRHEA)
-

Give Ceftriaxone and Doxcycline

Tell patient to stop high risk

behavior

Safe Sex Practice

-

Condom doesnt work for

herpes simplex, hpv

Surgical Treatment
-

Laparotomy
o Doxycycline causes
epigastric pain

Infertility
-

Most important and most

common long term complication
Tubal factor is affects

Chronic Pelvic Pain

-

Endometrium is in the
endometrial phase
Glycogen serves as food
Bacteria proliferates prior to
menstruation

Clinical Presentation
-

PEACH

Abdominopelvic Tuberculosis

Common in the younger age

group and developing countries

Pathogenesis

Mantoux Test/PPD screening

method
Paracentesis
o High protein content
Polymerase Chain Reaction TB
UTZ
Hysterosalphingography
Chest X-ray
Hydrosalphinx water in the
fallopian tube; adhesion
Langhan Giant Cells BOARD
EXAM QUESTION

TB in Filipinos
-

Tuberculosis affects the lungs

-

Ovarian malignancy
Pelvic Inflammatory Disease
Pelvic Abscesss
Meigs syndrome
Mycotic infections

Diagnosis:

13 hospitals:
o Vaginal douching high
risk for PID
Hormonal pills increase area of
transformation zone

Bloating
Ascites

Differential Diagnosis

Fitz- Hugh Curtis Syndrome

Lungs -> can go to the fallopian

tube, extrapulmonary lymh
nodes, direct spread,
hematogenous route

Start with RHZE (Quadruple)

o Give for 2 months
o HR for 4-7 months

Therapeutics:
-

CA-125

Surgical Treatment