Pelvic inflammatory disease

With females, there is cervicitis, discharge and an inflamed, nontender cervix. Spread can occur to the rectum, which is usually totally asymptomatic. Then spread can occur beyond the mucosa of the urethra, of the cervix, of the rectum and of the pharynx. These can be totally asymptomatic and then spread can occur either via the bloodstream or by direct extension. In the female, contiguous spread can occur and produce pelvic inflammatory disease, salpingitis or can actually go all the way through the fallopian tube into the peritoneal cavity and produce the syndrome called Fitz-Hugh-Curtis syndrome. It can produce perihepatitis, occasionally perisplenitis, then there may be bacteremic spread. Bacteremia can produce skin lesions and arthritis. Endocarditis at one time was fairly common from the gonococcus; five percent of all cases of endocarditis were caused by the gonococcus back before antibiotics. Now, it is a rare occasion to see gonococcal endocarditis; it almost doesn’t happen anymore. The explanation is absolutely lacking – nobody understands it, because it is not related to┬ácanadian antibiotics therapy and it may well be that the gonococcus has evolved and changed in nature so that it is far less prone to cause endocarditis. Occasionally, the gonococcus can cause meningitis. Some of the cases of apparent meningococcal meningitis, when looked at carefully, turned out to be a gonococcus and not meningococcus.

Pelvic inflammatory disease may be gonococcal, may be chlamydial or may be mixed aerobic and anaerobic organisms. What seems to happen is that the initial infection is usually either gonococcal or chlamydial and then the recurrent infections tend to be caused by genital organisms that are found normally in the vagina, mixed aerobes and anaerobes. Sometimes that first episode is barely symptomatic, so the first truly symptomatic episode that comes to the attention of the physician, seemingly the first episode, is actually caused by aerobic and anaerobic organisms. But the state is set by an initial gonococcal or chlamydial infection. There are greater than one million cases per year in the United States. One-third of these cases require admission to the hospital, which means that two-thirds of them can clearly be treated at home and ten percent go on to require a surgical procedure. One in four women with pelvic inflammatory disease will develop one or more chronic sequelae. Some of these sequelae are well known to you and they are all quite significant. There is a sevenfold increased risk of ectopic pregnancy because of the damage done to the fallopian tube. There is an eleven percent risk of infertility after only one episode.

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