Under Pelvic Inflammatory Disease (PID, pelvic infection, “Ovarian inflammation”) refers to an infection of the upper female genital tract (cervix, tubes and ovaries). Abscesses are possible. Common Symptoms include pain in the lower abdomen, cervical fluorine and irregular vaginal bleeding. Long-term complications include infertility, chronic pelvic pain and ectopic pregnancy. The diagnosis includes PCR testing of Zervixflüssigkeit to Neisseria gonorrhoeae and chlamydia, usually microscopic examination of zerikalen effluent and occasionally sonography or laparoscopy. Treatment is with antibiotics.
An infection of the cervix (cervicitis, cervicitis) gives a mucopurulent fluorine. Infections of the tubes (salpingitis) and uterus (endometritis) usually occur together. In severe cases, the infection can spread to the ovaries (oophoritis), then click the peritoneum (peritonitis) expand. Salpingitis endometritis and oophoritis, with or without peritonitis, is often described as salpingitis, even if other structures are involved. Pus may accumulate in the tubes (Pyosalpinx) and an abscess form (tubo-ovarian abscess).
Under Pelvic Inflammatory Disease (PID, pelvic infection, “Ovarian inflammation”) refers to an infection of the upper female genital tract (cervix, tubes and ovaries). Abscesses are possible. Common Symptoms include pain in the lower abdomen, cervical fluorine and irregular vaginal bleeding. Long-term complications include infertility, chronic pelvic pain and ectopic pregnancy. The diagnosis includes PCR testing of Zervixflüssigkeit to Neisseria gonorrhoeae and chlamydia, usually microscopic examination of zerikalen effluent and occasionally sonography or laparoscopy. Treatment is with antibiotics. An infection of the cervix (cervicitis, cervicitis) gives a mucopurulent fluorine. Infections of the tubes (salpingitis) and uterus (endometritis) usually occur together. In severe cases, the infection can spread to the ovaries (oophoritis), then click the peritoneum (peritonitis) expand. Salpingitis endometritis and oophoritis, with or without peritonitis, is often described as salpingitis, even if other structures are involved. Pus may accumulate in the tubes (Pyosalpinx) and an abscess form (tubo-ovarian abscess). Etiology PID occurs when microorganisms ascending from the vagina and cervix into the endometrium and into the tubes. Neisseria gonorrhoeae and Chlamydia trachomatis are common causes of PID; they are passed through the sexual contact. Mycoplasma genitalium, which is also transmitted sexually, can also lead to PID or contribute. In PID are usually other aerobic and anaerobic, including the pathogens of bacterial vaginosis (Bacterial vaginosis (BV)) involved. Risk Factors PID preferably relates to women under 35 years. Before menarche, after menopause and during pregnancy, the PID is very rare. Risk factors include Earlier PID presence of bacterial vaginosis or any disease that is spread through sexual intercourse. Other risk factors, especially for PID by gonorrhea or chlamydia are younger age non-white racial Low socioeconomic status Several or new sexual partners symptoms and discomfort abdominal pain, fever, cervical fluorine and abnormal uterine bleeding are common, especially during or after menses. Cervicitis the cervix is ??red and bleeding when touched (cervicitis: symptoms and complaints). Mucopurulent fluorine is a common finding; usually it is yellow-green and flows visible from the Zervikalkanal.Akute salpingitis abdominal pain are usually present on both sides, but can – even with the participation of both tubes – even unilaterally occur. Also, pain in the upper abdomen are possible. Nausea and vomiting occur in severe pain at times. Irregular bleeding (due to endometritis) and fever occur in up to one third of patients. In the early stages the characters can be slightly or missing. Later, a cervical movement pain, a guarding and a rebound tenderness usually are added. Occasionally there is dyspareunia or dysuria. In many women with such severe inflammation that scars form, the symptoms are minimal or absent. A PID on the floor of an infection with N. gonorrhoeae is usually acute and leads to stronger symptoms than the PID caused by C. trachomatis, which can run indolent. PID because M. genitalium, as well as by C. trachomatis, is also weak and should in women who do not respond to first-line treatment for PID, considered werden.Komplikationen Acute salpingitis on the floor of a gonococcal or chlamydial infection can for Fitz-Hugh- Curtis syndrome (associated with pain in the right upper abdomen perihepatitis) lead. The infection can be chronic, with exacerbation and remissions alternate. A tubo-ovarian abscess (a collection of pus in the appendages) develops in about 15% of women with salpingitis. It can occur in acute or chronic infection and is likely in late begun or abandoned treatment. Pain, fever and Peritonitiszeichen are usually available and can be pronounced. Resistance in the adnexal region may be palpable, even if the strong pressure sensitivity can be limited to the investigation. If it comes to rupture of the abscess, the symptoms increase rapidly; Septic shock is possible. A Hydrosalpinx is a Fimbrienverschluss and expansion of the tube by non-purulent fluid; they usually causes no symptoms, however, may be accompanied by a feeling of pressure in the pelvis, chronic pelvic pain, dyspareunia and / or infertility. A salpingitis can lead to scarring and adhesions in the tube, which often lead to chronic pelvic pain, infertility and an increased risk of ectopic pregnancy. Profound diagnostic PCR suspected pregnancy test PID must be excluded in women of childbearing age in which abdominal pain or cervical or unexplained Vaginalfluor occur, particularly if they have risk factors. A PID should be considered in irregular vaginal bleeding, dyspareunia or dysuria, for which no other explanation offered. PID is more likely in tenderness in the lower abdomen, unilateral or bilateral tenderness adnexal and cervical motion pain into consideration. A palpable resistance in the adnexal region may be caused by a tubo-ovarian abscess. Since even an infection with minimal symptoms can have serious consequences, the suspect should be investigated early. In cases of suspected PID Zervixsekretproben be gonorrhoeae by PCR for C. trachomatis and N. tested (sensitivity and specificity of about 99%) and a pregnancy test performed. If no PCR is possible cultures are set. However, if possible, an upper tract infection even if cervical specimens are negative. Usually, a rapid test for the confirmation of pus is performed in the cervical secretion; Although Gram stain or NaCl native preparation can be made, but these methods are neither sensitive nor specific. If sufficient palpation for pain is not possible, an ultrasound must be performed as soon as possible. Leukocytes can be increased, but this does not contribute to the diagnosis. A positive pregnancy test an ectopic pregnancy, which can cause a similar clinical picture must be considered. Other common causes of abdominal pain is endometriosis, a stalk twisted ovarian cyst, a ruptured ovarian cyst and appendicitis for differentiating features of this disease (Pelvic pain). The Fitz-Hugh-Curtis syndrome can initially be mistaken for acute cholecystitis, a distinction is usually, however, using a pelvic palpation, designed to accept a salpingitis, or possibly an ultrasound findings possible. Tips and risks if the clinical findings point to PID, but the pregnancy test is positive, should be investigated for an ectopic pregnancy. In clinically suspected pelvic resistance or, in the absence of improvement after 48-72 hours following an antibiotic, a sonographic examination is immediately required a tubo-ovarian abscess, a pyosalpinx and PID foreign diseases (such. As ectopic pregnancy, pedicle-turned exclude ovarian cyst). In unclear ultrasound findings laparoscopy is indicated; as a diagnostic gold standard is given to purulent material from the peritoneal cavity, which is noticed ending the Laproskopie. Treatment antibiotics against N. gonorrhoeae, C. trachomatis, and occasionally other agents antibiotics against N. gonorrhoeae and C. trachomatis are first administered empirically, then modified if necessary in accordance with the resistance test. An empirical treatment is always necessary if the diagnosis is questionable for several reasons: The test results (in particular, the rapid tests) are not unique. The diagnosis based on clinical findings may be inaccurate. If a PID is not treated with only slight symptoms, this can lead to serious complications. Tips and hazards May due to unclear test results (in particular the rapid tests) and not clear clinical findings not an exact diagnosis be made, should be treated empirically; PID is not treated with only slight symptoms, this can lead to serious complications. Patients with cervicitis or clinically subacute PID do not require hospitalization. Outpatient treatment regimens (see table: procedures for the treatment of Pelvic Inflammatory Disease *) are also usually against bacterial vaginosis (Bacterial vaginosis (BV): Treatment) directed, often simultaneously. The sexual partners of patients with infections caused by N. gonorrhoeae or C. trachomatis should also be treated. Schemes for the treatment of pelvic inflammatory disease treatment regimen * Alternative schemes Parenteral Scheme A: cefotetan 2 g iv every 12 h or cefoxitin 2 g i.v. every 6 h plus doxycycline 100 mg p.o. or iv every 12 h Scheme B: Clindamycin 900 mg i.v. every 8 h i.v. plus gentamicin 2 mg / kg (dose) or i.m., followed by a maintenance dose (1.5 mg / kg) every 8 h; if necessary, substitution by a single daily dose (. eg 3-5 mg / kg 1 time / day) – Oral treatment regimen A: ceftriaxone 250 mg i.m. unique plus doxycycline 100 mg po 2 times / day for 14 days po with or without metronidazole 500 mg 2 times / day for 14 days treatment regimen B: Cefoxitin 2 g i.m. and 1 g probenecid p.o., each unique plus doxycycline 100 mg p.o. 2 times / day for 14 days po with or without metronidazole 500 mg 2 times / day for 14 days treatment regimen C: Another parenteral cephalosporin 3rd generation (eg ceftizoxime, cefotaxime.) Plus doxycycline 100 mg po 2 times / day for 14 days po with or without metronidazole 500 mg 2 times / day for 14 days § fluoroquinolone A (z. B. levofloxacin 500 mg p.o. 1 time / day or 400 mg p.o. Ofloxacin 2 times / day for 14 days) with or without metronidazole 500 mg p.o. 2 times / day for 14 days || * Recommendations of the Centers for Disease Control and Prevention: Sexually Transmitted Diseases Teatment Guidelines, December 17, 2010. Available at www.cdc.gov/std/treatment. The clinical efficacy of parenteral and oral treatment of mild to moderate pelvic inflammatory disease (PID) appears to be similar. Based on clinical experience, usually within 24 hours after the occurrence of a significant clinical improvement, oral therapy can be started. An oral therapy may be considered to moderate severe acute PID for slight because the clinical results of an oral and parenteral therapy are similar. Speak the patients within 72 hours not in oral therapy, they should be re-examined to confirm the diagnosis; parenteral therapy should be given in outpatient or inpatient. § This scheme can be considered when parenteral administration of cephalosporin is not possible and the local prevalence and the individual risk for gonorrhea are low. Before treatment, a gonorrhea test must be carried out; with a positive test result is the following is recommended: Positive NAAT (nucleic acid amplification test): cephalosporin parenterally Positive gonorrhea culture: treatment based on the study of antibiotic susceptibility detection of quinolone-resistant Neisseria gonorrhoeae or unknown antibiotic sensitivity: cephalosporin parenterally || There is limited information on other patient therapies; Amoxicillin / clavulanic acid plus doxycycline or azithromycin, with or without ceftriaxone but may be clinically temporarily effective. The addition of metronidazole can be considered. If the state of patients after treatment, which includes the usual pathogens, does not improve, PGD should be considered because M. genitalium. Patients can empirically po 400 mg moxifloxacin 1 time / day for 7 to 14 days (e.g., 10 days) to be treated. Indications for hospitalization of women with PID are: Non Secured diagnosis, in which a disease that requires surgical treatment, can not be excluded (. Eg appendicitis) Pregnancy Severe symptoms or high fever tubo-ovarian abscess inability of the patient, outpatient therapy to follow or to be followed (z. B. at vomiting) Insufficient response to an out-patient (oral) treatment In such cases, iv administered after the presence of the culture results immediately and continued until the patient is afebrile for 24 hours antibiotics (Schemes for the treatment of pelvic inflammatory disease * see table). A tubo-ovarian abscess, the long-term administration of i.v. make antibiotics necessary. Treatment with percutaneous or transvaginal drainage under sonographic or CT view can be considered when therapy with antibiotics alone is not enough. For draining a laparoscopy or laparotomy is sometimes necessary. In cases of suspected rupture of a Tuboovarialabszesses immediate laparotomy is mandatory. In women of reproductive age, the preservation of the pelvic organs is desired (with the aim of preserving fertility). Summary sexually transmitted pathogen Neisseria gonorrhoeae and Chlamydia trachomatis are common causes of PID, but often there is a multi bacterial infection. PID can lead to the formation of scars and adhesions in the tubes, which often have chronic pelvic pain, infertility and an increased risk of ectopic pregnancy result. Since even an infection with minimal symptoms can have serious consequences, the suspect should be investigated early. PCR and cultures are reliable tests; are the rapid test is available, treatment is usually recommended on an empirical basis. Women with PID be hospitalized based on clinical criteria (see above).