Pelvic inflammatory diseases (PIPA)

Pelvic inflammatory diseases (PIPA)

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Pelvic inflammatory diseases (PIPA) means polymicrobial infectious lesions of the upper parts of the genital tract: cervical, uterine, uterine tubes, ovaries; an abscess may be present. VET may be sexually transmitted. The most common symptoms are pain in the lower parts of the abdomen, discharge from the cervical canal and irregular vaginal blood discharge. Removed complications include infertility, chronic pelvic pain and ectopic pregnancy.
Pelvic inflammatory diseases (PIPA) can affect the cervix, uterus, uterine tubes and/or ovaries. Cervical infection (cervicitis) is manifested by mucosa purulent detachment. Infection of the uterine tubes (salpingite) or the uterus (endometritis) usually occurs in combination. In a severe course, the infection may spread to the ovaries (oophoritis) and then to the peritoneum (peritonitis). Salpingite in combination with endometritis and oophoritis, with or without peritonitis, is often called salpingite, even if other organs are involved. Pus may accumulate in uterine tubes (piosalpinx); an abscess may form (tubo-ovarian abscess).

Etiology

Pelvic inflammatory diseases (PIPA)

The PIPA causes an infectious agent that goes upwards from the vagina and cervix to the endometrium and uterine tubes. PIPA usually also causes other aerobic and anaerobic bacteria, including pathogens associated with bacterial vaginosis. Vaginal microorganisms such as Haemophilus influenzae, Streptococcus agalactiae and intestinal gram-negative bacilli can cause inflammation of small pelvic organs (PID), as well as the bacteria of the genus Ureaplasma. Vaginal inflammation and bacterial vaginosis contribute to the upward proliferation of vaginal microflora.

Risk factors

Pelvic inflammatory disease, as a rule, occurs in women < 35. Pelvic inflammation rarely occurs before menarche, after menopause and during pregnancy.

Risk factors include:

  • Previous PSAs. The presence of bacterial vaginosis or any sexually transmitted diseases.
  • Other risk factors, especially for Gonorrhea or Chlamydia, include: younger age; non-membership of the white race; low socio-economic status; multiple sexual partners or a new sexual partner or a partner who does not use a condom; and sprinkling.

Clinical manifestations

Pelvic inflammatory diseases (PIPA)

Pelvic inflammation usually causes pain in the lower abdomen, fever, discharge from the cervical canal and abnormal uterine bleeding, usually during or after menstruation.

Cervicitis
In cervical cervicitis, the cervix is hyperimposed and bleeds easily. Characteristic of mucosa purulent discharge of yellow-green color from the cervical canal.

Acute salpingitis
Pain in the lower parts of the abdomen, bilateral or unilateral, even if both pipes are involved. Pain may also occur in the upper parts of the abdomen. Expressed pains are often accompanied by nausea and vomiting. Unregular bleeding (caused by endometritis) and fever occur in about a third of the patients.

In the early stages, symptoms may be absent or vague. In later stages, neck soreness and symptoms of peritoneal irritation appear. Dyspareunia or dysuria also sometimes appear. In many cases, when the inflammation is so severe that it causes scarring, symptoms of the disease are little or no.

Complications

Fitz-Hugh-Curtis syndrome (perihepatitis, which causes pain in the upper right quadrant) may be the result of acute gonococcal or chlamydia salpingitis. This infectious disease may acquire a chronic course, characterized by intermittent exacerbations and remissions.

Tubo-ovarian abscess (pus in uterine appendages) develops in about 15% of women with salpingitis. It can be caused by an acute or chronic infection and is most likely to occur with delayed or incomplete treatment. As a rule, there are pronounced pain, fever and peritoneal symptoms. Tumor formation of uterine appendages may be palpable, but examination is sometimes limited due to extreme pain. Rupture of the abscess leads to an increase in symptoms and possibly to septic shock.

Hydrosalpinx is the obstruction of the uterine tubes in the fimbria and the accumulation of fluid without pus in the uterine tubes; the disease is usually asymptomatic but may cause pressure on pelvic organs, chronic pelvic pain, dyspareunia and/or infertility.

Salpingitis can cause scarring and solder changes in the uterine tubes, resulting in pelvic pain, infertility and increased risk of ectopic pregnancy.

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