Good Morning 
Semantic Qualifiers
Symptoms
Acute /subacute
Chronic
Localized
Diffuse
Single
Multiple
Static
Progressive
Constant
Intermittent
Single Episode
Problem Characteristics
Ill-appearing/
Toxic
Well-appearing/
Non-toxic
Recurrent
Localized problem
Systemic problem
Abrupt
Gradual
Acquired
Congenital
Severe
Mild
New problem
Recurrence of old
problem
Painful
Nonpainful
Bilious
Nonbilious
Sharp/Stabbing
Dull/Vague
Illness Script

Predisposing Conditions
 Age, gender, preceding events
(trauma, viral illness, etc),
medication use, past medical
history (diagnoses, surgeries, etc)

Pathophysiological Insult
 What is physically happening in
the body, organisms involved, etc.

Clinical Manifestations
 Signs and symptoms
 Labs and imaging
Predisposing Conditions
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
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Adolescents/young adults
African American,
southeastern rural U.S.
Multiple sexual partners
Vaginal douching
Untreated episode of GC
or Chlamydia (10-40%)
Past history of STD or
previous PID
Menstruation
IUD

Protective factors**



Appropriate condom
usage
Other barrier protection
Oral contraceptives**
(decreases the risk by
up to 7-fold) in face of
gonococcal cervicitis
Pathophysiology
Ascending genital tract
infection…”salpingooophoritis”
 Inflammation of:

Endometrium
 Fallopian tubes
 Ovaries
 Peritoneum



Organisms

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**Immature cervix

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More ectopy (exposed
columnar epithelium)
Further predisposing
adolescents to the condition
GC/Chlamydia (50% of
cases)
Other




Bacteroides
Peptostreptococcus
Gardnerella vaginalis
H. influenza
Strep species
Enteric GNR
Genital Mycoplasms
**Polymicrobial
Clinical Manifestations**
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Lower abdominal pain, worse with
movement
Vaginal discharge
Irregular bleeding
Fever
Nausea/vomiting
Dyspareunia, dysmenorrhea,
dysuria
Physical Exam



Cervical motion tenderness
Adnexal tenderness
Mucopurulent vaginal or cervical
discharge
Evaluation**
Detailed history
 Abdominal and pelvic exam**
 Diagnostic tests**

 Cervical cultures for Gonorrhea and Chlamydia
○ Nucleic Acid Amplification Test (NAAT) – Urine, vaginal, or

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endocervical swab
Wet prep to rule out concurrent infections (yeast, BV, or
trichomoniasis)
Pregnancy test
UA +/- urine culture, CBC, ESR, CRP
Consider pelvic ultrasound
Screen for other STDs** (i.e. HIV, Syphilis)
Hospitalization**
Treatment**
Fitz-Hugh-Curtis Syndrome**
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Infection spills into peritoneum
and tracks superiorly through
the hepato-colic gutter
Inflammation of the hepatic
capsule (perihepatitis)
Symptoms


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
Colicky, RUQ abdominal pain
Vomiting
LFTS typically normal
RUQ US often normal…but can
show inflammation of the capsule
**Must be considered when
evaluating sexually active
adolescent with RUQ pain!!
Other Complications**
Tubo-ovarian abscess
 Recurrent infection
 Chronic abdominal/pelvic
pain pain
 Ectopic pregnancy

 Seven-fold increase!!

Infertility
 Risk increases with delayed
diagnosis, younger age of
infection, Chlamydial
disease, and severe PID
Patient Counseling
Be abstinent for at least 1 week after
treatment
 Contact sexual partners and encourage
their treatment

 “Expedited partner treatment” – give an
advance prescription to patients to assist
with treating sexual contacts

Future safe sex practices
Thanks 