Gynaecological Infections- Chapter 20:

Q 20. 1 What is an infection?

An infection is a disease process found in association with micro-organisms such as bacteria and viruses (Q3.5).

Q 20. 1 What is an infection.

Q 20. 2 What is acute pelvic inflammatory disease?

Q 20. 3 What is chronic pelvic inflammatory disease?

Q 20. 4 How is pelvic inflammatory disease treated?

Q 20. 5 What are pathogenic and commensal micro-organisms?

Q 20. 6 What is meant by venereal disease?

Q 20. 7 What problems can occur in people with gonorrhoea?

Q 20. 8 What problems can occur in people with syphilis?

Q 20. 9 What problems can occur in people with chlamydia?

Q 20. 10 What problems can occur in people with human papilloma virus (HPV)?

Q 20. 11 Could I contract a venereal disease without being aware of it?

Q 20. 12 What is pelvic tuberculosis?

Q 20. 13 What is pelvic actinomycosis?

Q 20. 14 What are HIV and AIDs?

Q 20. 15 How can I avoid getting HIV?

Q 20. 16 Should I have a test for HIV?

Q 20. 17 Could I have some useful Web sites?

Women’s Health – Home Page

Q 20. 2      What is acute pelvic inflammatory disease?

       Acute pelvic inflammatory disease is a condition associated with infection of the Fallopian tubes. Following childbirth or a miscarriage, infection may ascend through the uterus and reach the Fallopian tubes. Sometimes the initial infection may follow sexual intercourse. The blood count may suggest evidence of infection in the body. Initially, in the acute phase, there is active bacterial infection.

The inflammation may spread to surrounding structures including the ovaries. A variety of names have been used, the most common being salpingitis (inflammation of the Fallopian tubes) and salpingo-oophoritis (inflammation of the tubes and ovaries). In the acute phase, bacteria are  present. Typically the patient has general symptoms of infection including feeling unwell, fever and loss of appetite. There is pain in the pelvis and tenderness on either side of the uterus at pelvic examination. Several different bacteria may cause acute pelvic infection. A swab may be taken from the cervix by your doctor. It should be recognised that this is rather remote from the Fallopian tubes. The swab is sent to the laboratory where it is plated out on to a culture medium so to allow the responsible bacteria to be identified and the sensitivity to various antibiotics to be tested. Some micro-organisms known to be implicated in pelvic inflammatory disease, such as Mycoplasma hominis, are difficult to culture and may be missed. If the Fallopian tubes are visualised at laparoscopy (Q23.24) they appear inflamed.             

Q 20. 1  What is an infection.

Q 20. 2  What is acute pelvic inflammatory disease?

Q 20. 3  What is chronic pelvic inflammatory disease?

Q 20. 4  How is pelvic inflammatory disease treated?

Q 20. 5  What are pathogenic and commensal micro-organisms?

Q 20. 6  What is meant by venereal disease?

Q 20. 7  What problems can occur in people with gonorrhoea?

Q 20. 8  What problems can occur in people with syphilis?

Q 20. 9  What problems can occur in people with chlamydia?

Q 20. 10  What problems can occur in people with human papilloma virus (HPV)?

Q 20. 11  Could I contract a venereal disease without being aware of it?

Q 20. 12  What is pelvic tuberculosis? 

Q 20. 13  What is pelvic actinomycosis?

Q 20. 14  What are HIV and AIDs?

Q 20. 15  How can I avoid getting HIV?

Q 20. 16  Should I have a test for HIV?

Q 20. 17  Could I have some useful Web sites?

Women’s Health – Home Page

Q 20. 3 What is chronic pelvic inflammatory disease?

If the acute infection is not treated or does not respond quickly to antibiotics there may be long-term structural damage leading to chronic pain and infertility. Chronic pelvic inflammatory disease may occur from repeated episodes of acute infection or if an acute episode has not been treated or fails to respond to antibiotics. There may be adhesions (scar tissue) tethering the Fallopian tubes and ovaries to surrounding structures. The tubes may become blocked causing infertility (Q9.3). When the Fallopian tubes are blocked at their outer ends, the tubes may fill with fluid (hydrosalpinx). If the pain does not respond to antibiotics, local heat treatment supervised by a physiotherapist may provide symptomatic relief. Occasionally surgery may be required to remove the diseased organs.

Q 20. 4 How is pelvic inflammatory disease treated?

In the acute phase, appropriate antibiotics are likely to cure the illness. In the early stages the antibiotics can be taken by mouth. In more severe situations, admission to hospital and intravenous antibiotics may be indicated. On occasion, acute infection may be severe enough to produce a pelvic abscess, which may require surgery to drain the pus.

Q 20. 5 What are pathogenic and commensal micro-organisms?

Several of the body’s organs including the bowel and the vagina are not sterile. A swab test from the upper vagina (HVS – high vaginal swab) is usually taken if you have problems with vaginal discharge or if it is thought that you may have pelvic infection. If a swab sample is sent for culture many bacteria or other micro-organisms are invariably identified. It is a matter of clinical judgement whether any of these are causing a problem for you in which case we would call them pathogens (generating pathology – disease). If they are innocent we call them commensals. It should be recognised that a swab from the upper vagina may not reflect the situation in the uterus or Fallopian tubes.

Q 20. 6 What is meant by venereal disease?

The venereal diseases (VD) are infections usually acquired during sexual intercourse. They are also referred to as sexually transmitted diseases (STDs). The organisms that cause these diseases are very fragile and cannot survive outside the body. They can thrive in warm, moist dark areas including the genital area, anus and mouth. Historically, the two more common diseases in peoples’ minds have been gonorrhoea and syphilis. Gonorrhoea is due to a bacterium called Neisseria gonorrhoea and syphilis is due to a spiral organism called Treponema pallidum. Other diseases that may be transmitted by sexual contact include the herpes simplex virus and the wart virus.

Q 20. 7 What problems can occur in people with gonorrhoea?

Gonorrhoea is the result of an infection with the bacterium Neisseria gonorrhoea that is sexually transmitted. In the acute phase, gonorrhoea is associated with a pus-like discharge from the genital organs starting between two and eight days after intercourse. Increased frequency of bladder emptying is more common in men than women. Some women may not notice any obvious symptoms. The infection can reach the Fallopian tubes leading to irreversible damage (Q20.3). In the acute phase of gonorrhoeal pelvic infection, there may be an elevated temperature, a feeling of being unwell and pelvic pain and tenderness. Even after the acute illness there may be chronic symptoms of pelvic pain and period problems (chronic pelvic inflammatory disease).

Acute infections respond to antibiotics particularly penicillin.

Q 20. 8 What problems can occur in people with syphilis?

Syphilis is caused by the organism T. pallidum. With the initial infection, the majority of the organisms are focused at the site where they enter the body. About four weeks after infection a painless hard sore can be seen. This is the characteristic sign of primary syphilis. The organisms subsequently reach all parts of the body. About ten weeks after infection there may be fever and generalised ill health. There is a typical dull red, raised rash all over the body including the palms and soles of the feet. This is secondary syphilis.

Following secondary syphilis, about one third of those affected never have any further problems. The others enter a latent phase before the late or tertiary phase of the illness, which may cause disfiguration and damage to the nervous system and the heart. Syphilis can be transmitted across the afterbirth to affect the unborn child in pregnancy. The T.pallidum organism is sensitive to penicillin which cures the condition in the primary and secondary phases.

Q 20. 9 What problems can occur in people with chlamydia?

Chlamydia trachomatis is a microorganism that can cause inflammation in the urethra (the tube leading out from the bladder), pelvic inflammation (Q20.2) and eye infection of the newborn.

It is one of the more common of the sexually transmitted diseases. Chlamydia are sensitive to antibiotics including erythromycin and the tetracyclines.

Q 20. 10 What problems can occur in people with human papilloma virus (HPV)?

The human papilloma virus is responsible for warts. The virus is transmitted by direct contact. Some types of HPV are responsible for pre-malignant and malignant conditions of the cervix (Q21.12). Warts can be destroyed by chemicals (notably podophyllin), cautery, laser and freezing (cryotherapy).

Q 20. 11 Could I contract a venereal diseases without being aware of it?

Some venereal diseases, including syphilis, gonorrhoea, chlamydia, herpes simplex (Q31.3), the human papilloma virus and HIV (Q20.14) do not always show local signs in women. If you have placed yourself at risk, it is advisable to seek medical advice

Q 20. 12 What is pelvic tuberculosis?

Tuberculosis is a chronic bacterial infection, caused by mycobacterium tuberculosis , that most commonly affects the lungs but can affect other organs including those in the pelvis. Infertility, pain in the pelvis, period problems and poor general health may result from pelvic tuberculosis. The diagnosis can usually be determined by histopathology (Q23.11). Special combinations of anti-tuberculosis drugs are required for several months.

Q 20. 13 What is pelvic actinomycosis?

This is an uncommon chronic infection in the pelvis usually associated with the use of an intrauterine contraceptive device (Q17.16).

Q 20. 14 What are HIV and AIDs?

The acquired immuno-deficiency syndrome (AIDS) was first described in the male homosexual community in New York and Los Angeles in 1981 but it has spread to the heterosexual population. Historically, fear of gonorrhoea and syphilis was the greatest concern with regard to promiscuity. Penicillin provides a cure for these potentially serious conditions but now the worry has become acquired immuno-deficiency syndrome (AIDS).

The causative virus, the human immuno-deficiency virus (HIV), can be found in vaginal secretions, semen, breast milk and the blood. If a blood test confirms the presence of the virus before there is any evidence of illness, the patient is said to be “HIV positive”. It is currently believed that invariably HIV positive patients will go on to develop AIDS. Usually this will occur within a few years although there are reports of intervals of up to sixteen years. People without AIDS but who are HIV positive can infect others. Whereas the majority of bacterial conditions respond to antibiotics, viruses are relatively resistant to medication. The human immuno-deficiency virus attacks the immune system, which is the body’s main defence mechanism.

The virus may lay relatively dormant for a few years before generalised ill health and a predisposition to infections indicates the possibility of the disease called AIDS. Modern medication can delay the rate of progress of the disease but a cure remains to be found. People with AIDS are extremely susceptible to infection and tumours and the condition is almost invariably fatal.

HIV can be transmitted to a baby during pregnancy and childbirth. Medication during pregnancy, elective Caesarean section, and artificial rather than breast feeding reduce the risks to the baby. Transmission is not confined to intravenous drug users or homosexual men. Generally, when the body is subjected to infection, the immune system recognises the invading organism. Those who have had casual sexual encounters may have fears about this infection but may be reluctant to approach their doctor or attend a genitourinary clinic. There are times when only a negative HIV test will resolve anxieties. Careful counselling is essential before the test is conducted partly because of the possibility of a positive result and partly because being tested may have other implications.

Q 20. 1 What is an infection.

Q 20. 2 What is acute pelvic inflammatory disease?

Q 20. 3 What is chronic pelvic inflammatory disease?

Q 20. 4 How is pelvic inflammatory disease treated?

Q 20. 5 What are pathogenic and commensal micro-organisms?

Q 20. 6 What is meant by venereal disease?

Q 20. 7 What problems can occur in people with gonorrhoea?

Q 20. 8 What problems can occur in people with syphilis?

Q 20. 9 What problems can occur in people with chlamydia?

Q 20. 10 What problems can occur in people with human papilloma virus (HPV)?

Q 20. 11 Could I contract a venereal disease without being aware of it?

Q 20. 12 What is pelvic tuberculosis?

Q 20. 13 What is pelvic actinomycosis?

Q 20. 14 What are HIV and AIDs?

Q 20. 15 How can I avoid getting HIV?

Q 20. 16 Should I have a test for HIV?

Q 20. 17 Could I have some useful Web sites?

Women’s Health – Home Page

Q 20. 15 How can I avoid getting HIV?

As people without symptoms can pass on the virus unknowingly, there is always a danger of having intercourse with someone with HIV. The more partners you have the greater the risk. ‘Safe-sex’ means using a condom at all times.

Q 20. 16 Should I have a test for HIV?

If you feel that you could be at risk, the current advice is to be tested. Hopefully your result will be negative and you can be reassured. If your test does prove to be positive, treatment can improve your future health.

Q 20. 17 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter

Q 20. 1 What is an infection.

Q 20. 2 What is acute pelvic inflammatory disease?

Q 20. 3 What is chronic pelvic inflammatory disease?

Q 20. 4 How is pelvic inflammatory disease treated?

Q 20. 5 What are pathogenic and commensal micro-organisms?

Q 20. 6 What is meant by venereal disease?

Q 20. 7 What problems can occur in people with gonorrhoea?

Q 20. 8 What problems can occur in people with syphilis?

Q 20. 9 What problems can occur in people with chlamydia?

Q 20. 10 What problems can occur in people with human papilloma virus (HPV)?

Q 20. 11 Could I contract a venereal disease without being aware of it?

Q 20. 12 What is pelvic tuberculosis?

Q 20. 13 What is pelvic actinomycosis?

Q 20. 14 What are HIV and AIDs?

Q 20. 15 How can I avoid getting HIV?

Q 20. 16 Should I have a test for HIV?

Q 20. 17 Could I have some useful Web sites?

Women’s Health – Home Page