– Bacterial infections of the uterus (endometritis) and / or fallopian tubes (salpingitis) may progress to pelvic peritonitis, pelvic abscess or septicemia. These infections can be a venereal or puerperal origin.
– Venereal infections are often due to Neisseria gonorrhoeae and Chlamydia trachomatis.
– Puerperal infections are often caused by anaerobic bacteria or bacteria normally present in the vaginal flora.
Clinical signs of venereal infections:
Suggestive symptoms are: abdominal pain, fever, dyspareunia, vaginal discharge, dysmenorrhea, menorrhagia, metrorrhagia, dysuria, and sometimes nausea and vomiting. The fever is not always present.
Pelvic inflammatory disease is probable when one or more of these symptoms are associated with pain on palpation of the annexes, pain in cervical motion, the presence of a low genital infection, the presence of a painful abdominal mass .
What to do (according to WHO):
Hospitalization criteria:
– Pregnant woman
– Uncertain diagnosis
– Need to remove an ectopic pregnancy or appendicitis
– Suspected pelvic abscess
– Serious illness preventing outpatient treatment
– Unable to follow or tolerate an outpatient treatment
– No improvement after 72 hours of treatment
Treatment of venereal infections:
– Must be effective against Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria.
– Remove a possible intrauterine device.
– Antibiotic treatment:
• In outpatient associate:
ceftriaxone IM: 125 mg single dose or cefixime PO: 400 mg single dose or spectinomycin IM (except pregnant women): 2 g single dose
PLUS
doxycycline PO: 200 mg / day in 2 divided doses for 14 days or, in pregnant or nursing, erythromycin PO: 2 g / day divided into 2 or 4 doses for 14 days
PLUS
metronidazole PO: 1 g / day in 2 divided doses for 14 days
Patients treated in outpatient are reviewed 72 hours after starting treatment and hospitalized if clinically is the same or deteriorated.
• In hospital, associate:
ceftriaxone IM: 250 mg / once daily
or spectinomycin IM (except pregnant women): 4 g / day in 4 divided injections
PLUS
doxycycline PO: 200 mg / day in 2 divided doses or in pregnant or nursing, erythromycin PO: 2 g / day in 2 or 4 sockets
PLUS
Metronidazole PO or IV 1 g / day in 2 divided doses or infusions
or chloramphenicol PO or IV (except pregnant women): 2 g / day in 4 divided doses or injections
Treatment lasts at least two days after clinical improvement and should be followed by treatment with doxycyclinePO: 200 mg / day in 2 divided doses for 14 days (erythromycin in pregnant women).
Clinical signs of puerperal infections original:
High fever with chills, abdominal pain, pus or foul smelling lochia, uterus large, soft and painful shock sometimes, following childbirth, spontaneous or induced abortion.
Treatment original puerperal infections:
– It is impossible in practice to distinguish endometritis from salpingitis or parametritis. Treatment should cover the pelvic infection as a whole.
– Antibiotic treatment:
ampicillin IV: 8 g / day divided into 3 or 4 injections
+ Gentamicin IM: 5 mg / kg / once daily
+ Metronidazole PO: 1.5 g / day in 3 divided doses
Continue treatment 48 hours after the complete disappearance of fever.
– In case of retained placenta, perform digital curettage (in helping if needed a curette, the widest possible).
– Suspicion of peritonitis or pelvic abscess: same antibiotics and consider surgical treatment.
1 * Note: ciprofloxacin, doxycycline and spectinomycin are cons-indicated in pregnant or lactating women; refer to the text body.