Makindo Medical Notes.com

Lower abdominal pain and adnexal tenderness are the most consistent findings

About

• May be due to Salpingitis
• Infective cause of pelvic pain and inflammation and infertility

Aetiology

• Chlamydia trachomatis, Neisseria gonorrhoea
• Escherichia coli, Anaerobic and haemolytic streptococci
• Staphylococci, Clostridium welchii

Clinical

• Pyrexia > 38°C, pelvic pain, Cervical excitation
• Abnormal vaginal bleeding, Deep dyspareunia
• Associated vaginal discharge, lower back pain
• Adnexal tenderness, masses or swelling may be seen

Differentials

• Appendicitis, Crohn's disease, Ulcerative colitis
• Ectopic pregnancy, Renal stones, Urinary tract infection

Complications

• Tubal damage and infertility, Pelvic inflammatory disease
• Septicaemia, Abscess formation which may require surgical drainage

Long term complications

• Infertility, Ectopic pregnancy x 5 risk
• Painful intercourse, Chronic pain, Painful periods
• Peritonitis, Abscess formation

Investigations

• FBC: Raised WCC and ESR, U&E, LFTs, CRP
• Ultrasound, Laparoscopy

Management

• It is important to grasp that the initial infection damages the normal innate immunity protection e.g. endocervix and tubal mucosa such that secondary infection is possible which can lead to further damage.
• This is why early treatment is needed. Antibiotics covering Chlamydia must be given e.g. Doxycycline but not if the patient pregnant then give Erythromycin. Additional antibiotics covering Gonorrhoea, such as Ciprofloxacin and Metronidazole to cover anaerobes may also be needed.
• The patient should be referred to the local genitourinary medicine clinic for contact tracing. This will allow previous partners and their contacts to be treated. It will also make reinfection less likely - a good point to stress to encourage compliance.
• May need IUCD removal if symptoms do not resolve within 72 hours off antibiotics - take gynaecological advice

References