0071643192.pdf

OBSTETRICS AND GYNECOLOGY

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CERVICITIS

■ Inflammation/infection of the cervix

■ Most common infectious causes are chlamydia and gonorrhea; however,

herpes simplex and trichomoniasis can also cause cervicitis.

■ Infectious cervicitis is usually associated with vaginitis.

SYMPTOMS/EXAM

■ Vaginal discharge is the primary symptom.

■ A red, inflamed, and congested cervix may be seen on exam.

■ In trichomonal infection, a “strawberry” cervix can be seen.

DIFFERENTIAL

■ Noninfectious cervicitis due to increased mucous discharge at ovulation

■ Infectious cervicitis

■ Early neoplastic process

DIAGNOSIS

Physical exam and wet mount can help identify the cause of acute cervicitis.

TREATMENT

Unless a specific etiology is identified, outpatient treatment of bothchlamy-

dia and gonorrhea is recommended.

■ Ceftriaxone (125–250 mg IM) and

■ Doxycycline (100 mg PO bid ×7 days) or azithromycin (1 g single PO

dose)

PELVIC INFLAMMATORY DISEASE

CAUSES

PID is an ascending infection from the lower genital tract that makes up a

spectrum of disease that ranges from endometritis to salpingitis and tuboovar-

ian abscess (TOA). Neisseria gonorrhoeaeandChlamydia trachomatisare the

most common causes. Simultaneous infection occurs.

Risks factors for PID include multiple sexual partners, history of sexually

transmitted diseases, young age, and use of an IUD.

SYMPTOMS

■ Most common presenting complaint is lower abdominal pain.

■ Often associated with abnormal vaginal discharge, vaginal bleeding, post-

coital bleeding, dyspareunia, fever, malaise, and nausea and vomiting.

■ Symptom onset is usually 2–5 days after menstruation.

EXAM

■ Lower abdominal tenderness

■ Mucopurulent cervicitis

■ Cervical motion tenderness

■ Bilateral adnexal tenderness

■ Unilateral adnexal tenderness or unilateral mass suggest TOA.

Chandelier sign = severe

cervical motion tenderness

seen with PID.

Use transvaginal ultrasound

to rule out TOA in patients

with PID and unilateral pelvic

tenderness.