Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Pediculosis Pelvic Inflammatory Disease 1145

management

■Eradication of all live lice, destroying incubating larvae, nit removal,

treatment of secondary infection

■Treat all family members, regardless of symptoms

■Instruct family that personal use items and bedding must be

deloused

specific therapy

■Pyrethrins (RID): OTC, not ovicidal so require repeat application 1

week later

■Pyrethroids (Permethrin=Nix): single, 10-minute treatment appli-

cation

■Lindane (Kwell): removes adults but not nits; requires second appli-

cation

■Ivermectin might be used in extremely severe or recalcitrant cases

follow-up

■One month to assess treatment response

complications and prognosis

■Commonly secondarily infected, particularly impetigo, requiring

further therapy

■No long-term sequelae if properly treated

PELVIC INFLAMMATORY DISEASE

SARAH STAEDKE, MD

history & physical

History

■Pelvic inflammatory disease (PID) encompasses a spectrum of

female genital tract disorders including endometritis, salpingitis,

tubo-ovarian abscess, and peritonitis.

■PID is typically an ascending, polymicrobial infection caused by N.

gonorrhoeae, C. trachomatis, vaginal flora (anaerobes and faculta-

tive organisms), and possibly M. hominis and U. urealyticum.

■Risk factors: young age; contraception (decreased risk with bar-

rier methods and OCPs, increased with IUDs); habits (douching,

smoking); invasive procedures (IUD insertion, dilatation and curet-

tage, induced abortion, hysterosalpingography), menses

■HIV infection may increase risk and influence clinical course of PID.