Infection of The Cervics 1

INFECTION OF THE CERVICS
INTRODUCTION
• Infection that affect the vagina also produce acute cervicitis
A. ACUTE CERVICITIS
• Usually occurs in association with generalized infection of
the genital tract and diagnosis is made and treated as per
vulvovaginitis management
SYMPTOMS AND SIGNS
• Purulent vaginal discharge
• Sacral backache
• Lower abdominal pain (LAP)
• Dyspareunia
• dysuria
A. ACUTE CERVICITIS
DIAGNOSIS
 Examination
• (speculum)
• Cervical swabs for culture
 Treatment depends on infecting organisms.
• Chronic cervicitis
• Common – 50-60 of parous women
• Symptoms usually minimal
• May be slight mucopurulent discharge
• In severe form there is profuse vaginal discharge,
chronic sacral backache
A. ACUTE CERVICITIS
• Dyspareunia occasionally post coital bleeding

• The cervix is often lacerated and there is
mucopurulent discharge from cervical canal
• Infection in the ducts of the endocervical glands
results in obstruction of these ducts and
development of small retention cysts is usable on
ectocervix.
• These cysts may simply contain mucus or
mucopus in severe infection
A. ACUTE CERVICITIS
• They are usually 2-3mm in diameter but may
be 1cm and are known as Nabothian follicles
or cysts.
• Bactenological culture of the discharge usually
sterile
• The condition may cause subfertility because
of hostility of the cervical mucus to sperm
invasion
A. ACUTE CERVICITIS
TREATMENT
• Medical treatment- rarely effective
• Most effective management – diathermy of
endocervix in order to cauterize.
• Nabothian follicles so that the discharge is
released.
• Following diathermy an antibacteria cream
should be placed in the vagina
• Avoid intercourse 3 weeks
B. HUMAN PAPILLOMA VIRUS (HPV)
• Certain types of HPV are found in a
association with neoplastic changes in the
cervix.
• Types 6 and 11 are associated with low grade
cervical intra-epithelial neoplasia (CIN) and
Condyloma, whereas serotypes 16, 18, and 28
are associated with all grades of CIN and
carcinoma of the cervix
ACUTE INFECTIONS OF THE UPPER
GENITAL TRACT
• Acute infection of the endometrium, myometrium
fallopian tubes and ovaries are usually the results of
ascending infections from the lower genital tract
causing pelvic inflammatory disease .
• However, infection may be secondary to appendicitis or
other bowel infections which some times give rise to a
pelvic abscess
• Pelvic sepsis commonly occurs during puerperium and
after an abortion.
• Retained placental tissue and blood provide an
excellent culture medium for organisms from the
bowel including Escherichia Coli, clostridium welchii or
C. perfinges, staphylococcus aureus and streptococcus
faecalis
ACUTE INFECTIONS OF THE UPPER
GENITAL TRACT
• The principle organisms to be cause acute
salpingitis by sexual transmission is Neisseria
gonarrhoea.
• The organism spreads across the surface of the
cervix and endometrium and causes tubular
infection within 1-3 days of contact.
• Acute infection may also be caused by chlamydia
which is now the most common cause of sexually
transmitted PELVIC INFLAMMATORY DISEASE
PELVIC INFLAMMATORY DISEASE
• It affects approximately 1% per year of women
between 15 and 35 years of age in th developed
world.
• The disease is most common between 15 and
24yrs
RISK FACTORS FOR PID
• Early sexual debut
• Women < 25 years
• Sexual promiscuity
• Low social economic status
• Bacterial vaginosis
PROTIVE FACTORS ASSOCIATION
• Barrier contraception
• Oral contraception
• Tubal ligation
• Pregnancy
SIGN AND SYMPTOMES OF ACUTE SALPIGITIS
• Acute bilateral lower abdominal pain
• Mucupurutent vaginal discharge
• Pyrexia > 38 degree some times with rigors
• Vomiting and diarrhoea
• Dyspareunia
SIGN AND SYMPTOMES OF ACUTE
SALPIGITIS
THE SIGNS INCLUDE
1. Signs of systemic illness with pyrexia and
tachycardia, hypotention
2. Signs of peritonitis with guarding or rebound
tenderness.
3. On pelvic examination, acute pain or cervical
excitation and thickening in the vagina fornicles,
which may be associated with cystic tubal
sweeling due to pyosapinges or pus- filled tubes.
fullness in the pouch of douglas suggests the
presence of pelvic abscess
DIFFERENTIAL DIAGNOSIS OF
SALPINGITIS
• It is often difficult to establish the diagnosis of
acute pelvic infection with any degree of
certainty
• The differential diagnosis include
1. Tubal ectopic pregnancy
• Wcc- normal
• HB- low
• PID- wcc >
-HB >
DIFFERENTIAL DIAGNOSIS OF
SALPINGITIS
2. Acute appendicitis
• Unilateral nature of condition
3. Acute urinary tract infection
• Urinary symptoms
4. Torsion or rupture of ovarian cyst
SALPINGITIS INVESTIGATION
• Swabs to be taken from cervical canal and
urethra.
• Midstream specimen of urine
• Wcc, hb, erythrocyte sedimentation rate ( ESR)
• Blood culture – in pyrexia
• Ultrasonography
MANAGEMENT OF SALPINGITIS
• Patient who is unwell and exhibits peritonitis
high-grade fever, vomiting, PID mass, manage as
follows.
MANAGEMENT OF SALPINGITIS
1. Fluid replacement by IV therapy
2. Antibiotic therapy cefuroxime, metronidazole,
doxycycline
3. Pain relief with opiates therapy
4. If ICDU in uterus it must be removed.
5. Bed rest
If patient is systematically well can be treated as
outpatient indication for surgical interventions
where condition does not resolve and where there
is a pelvic mass
CHRONIC PELVIC INFECTION
• Acute pelvis infections may progress to a chronic
state with dilatation and obstruction of the tubes
forming bilateral.
• Hydrosalpanges with multiple pelvic adhessions
SYMPTOMS
1. Chronic pelvic pain and sacral bachache
2. Chronic purulent vaginal disease
3. Epimenorrhagia and dysmenorrhoe
4. Deep seated dyspareunia
SIGNS
• Purulent discharge from cervix uterus often
fixed in retroversion thickening in the fornices
and pain on bimanual examination
management.
• Conservative management of this condition is
rarely effective and in the problem is only
resolved by clearance of the pelvic organs
SIGNS
• Chronic tuberculosis of the genital tract
• Tuberculosis salpingitis occurs in 15 5-10% of
women with pulmonary tuberculosis and
follows the spread
• The organism also causes chronic endometritis
and the diagnosis can be done by culture and
histologic examination of the curretings
MANAEMENT
• Anti TB treatment- will cure condition but not
restore fertility
HUMAN IMMUNEDEFICENCY VIRUS
(HIV) 1 & 2 AND PID
• The organisms associated with PID are sexually
transmitted as is HIV
• Therefore it is not uncommon for HIV and PID to
coincide is appears that HIV infected women have
more frequent episode of PID compared with
women not infected with HIV
• HIV positive and HIV negative patients with PID
demonstrate similar symptomatology
• The incidence of tubo-ovarian abscess appears to
be increased in HIV- infected women compared
to HIV negative patients
• However respond to medical is equally good.
• HIV Positive and HIV negative patients
demonstrate a similar microbiological profile
• Hoever HIV positive patients often in other
coexistent infections such as
Mycoplasma,hominis, candida ssp,
streptococcal and HPV infection
CO 2014 INTAKE

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INFECTION OF THE CERVICS

• Dyspareunia occasionally post coital bleeding

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