Epidemiology

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Etiology

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• Pathogens
  • Most common: Chlamydia trachomatis, Neisseria gonorrhoeae
• Risk factors
  • Multiple sexual partners, unprotected sex
  • History of prior STIs and/or adnexitis
  • Intrauterine devices
    • Patients with long-term intrauterine devices (IUDs) are at increased risk for developing an active Actinomyces infection, as evidenced by this patient’s culture that reveals acute-angle branching, gram-positive bacilli.

Pathophysiology

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Clinical features

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• Lower abdominal pain (generally bilateral), which may progress to acute abdomen
• Nausea, vomiting
• Fever
• Dysuria, urinary urgency
• Menorrhagia, metrorrhagia
• Dyspareunia
• Abnormal vaginal discharge (yellow/green color)

Diagnostics

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Treatment

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• Broad-spectrum antibiotic regimen, similar to Urethritis > Treatment

Complications

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• Long-term complications
  • Pathophysiology: inflammation (e.g., salpingitis) →
    • Tubal scarring
    • Adhesions of the fallopian tubes and ovaries
    • Hydrosalpinx: the accumulation of fluid in the fallopian tubes
  • Manifestations
    • Tubal infertility (related to loss of tubal ciliary function)
    • Ectopic pregnancy
    • Chronic pelvic pain