A Simple Guide to Pelvic Inflammatory Disease

A Simple Guide to Pelvic Inflammatory Disease
--------------------------------------------------------
What is Pelvic Inflammatory Disease?
---------------------------------------------

Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
These include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.

What is the cause of PID?
------------------------------

It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea.

The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.

Sexually active women in their childbearing years are most likely to get PID.
Women under age 25 are more likely to develop PID than those older than 25.
The cervix of young women is not fully matured, and therefore more prone to be infected by STD.

Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.

Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.

What are the signs and symptoms of PID?
--------------------------------------------------

Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.

Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).

How is PID diagnosed?
---------------------------

Because the symptoms are often subtle and mild, most cases of PID go undetected.

Diagnosis is usually based on clinical findings:
1.lower abdominal pain

2.abnormal cervical or vaginal mucopurulent discharge

3.oral temperature >101°F (>38.3°C)
together with investigation findings
4.laboratory evidence of gonorrheal or chlamydial infection.

5.A wet specimen of vaginal fluid is able to detect the presence of concomitant infections ( bacterial vaginosis and trichomoniasis)

6. pelvic ultrasound is a helpful procedure for diagnosing PID.It can check the pelvic area to see whether there is an abscess or enlarged fallopian tubes.

7.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end in inserted through a cut in the navel area to view the internal pelvic organs and to take specimens for testing.
Other criteria for diagnosing PID include the following:
8.endometrial biopsy with histopathologic evidence of endometritis;

9.transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex,

10.doppler studies suggesting pelvic infection

What are the complications of PID?
-----------------------------------------

Prompt and appropriate treatment can help prevent complications of PID.

Without treatment, PID can cause

1. permanent damage to the female reproductive organs.
Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.

2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.

3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow.
As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting in abdominal pain, internal bleeding, and death.

4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.

5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.

6. abscess formation in the reproductive organs or pelvis which can spread to the blood and cause septicemia.

What is the treatment for PID?
-------------------------------------

Treatment of PID should be initiated in
1.sexually active young women

2. pelvic or lower abdominal pain,

3. physical examination shows cervical motion tenderness, uterine tenderness or adnexal tenderness.

PID can be treated with several types of antibiotics(eg.clindamycin or metronidazole with doxycycline).
However, antibiotic treatment will not reverse any damage to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is important that she seek care immediately.
Prompt antibiotic treatment can prevent severe damage to reproductive organs.

PID is usually treated with at least two antibiotics given by mouth or by injection.
Even if symptoms go away, the woman should finish taking all of the prescribed medicine.
This will help prevent the infection from returning.

Hospitalization to treat PID may be recommended if the woman
(1) is severely ill with nausea, vomiting, and high fever

(2) is pregnant;

(3) does not respond to or cannot take oral medication and needs intravenous antibiotics;

(4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess).

(5)surgical emergencies (e.g., appendicitis) cannot be excluded;

If symptoms continue or if an abscess does not go away, surgery may be needed.

Complications of PID such as chronic pelvic pain and scarring improve with surgery.

How can PID be prevented?
--------------------------------

1. transmission of STDs can be prevented by abstainance from sexual intercourse,

2. a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected can prevent STD.

3.Latex male condoms, when used consistently and correctly, can reduce the transmission of chlamydia and gonorrhea.

4.chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections especially those with a new sex partner or multiple sex partners

5.Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles suggests a STD infection. Early treatment of STDs can prevent PID.

6. Intrauterine contraceptive devices containing levonorgestrel-and copper-containing devices may cause PID and should be removed if antibiotics does not cure the PID.

A Simple Guide to Gonorrhea

A Simple Guide to Gonorrhea
-----------------------------------

What is Gonorrhea?
------------------------

Gonorrhea is a sexually transmitted disease caused by the gram negative bacteria Neisseria gonorrhoeae.

How is gonorrhea spread?
-----------------------------

Gonorrhea is a very common infectious disease, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra in women and men.
The bacterium can also grow in the mouth, throat, eyes, and anus.

Gonorrhea is spread by infected people through contact with the penis, vagina, mouth, or anus.
There is no life long immunity after tratment with Gonorrhea.
A person who has been treated for gonorrhea may get infected again if there is sexual contact with a person infected with gonorrhea.
Gonorrhea can also be spread from mother to baby during delivery.

Who is at risk for gonorrhea?
-----------------------------------

Any sexually active person can be infected with gonorrhea if their partner has the disease.

What are the symptoms of gonorrhea?
---------------------------------------------

A high percentage of men with gonorrhea do not have any symptoms at all.
Some men have some symptoms that appear two to five days after infection.
Symptoms include
1.a burning sensation when urinating, or a white, yellow, or green discharge from the penis.

2. painful or swollen testicles.

In women the symptoms of gonorrhea are often mild.
Most women who are infected have no symptoms.
The initial symptoms in women include
1.a painful or burning sensation when urinating,

2.increased vaginal discharge,

3.vaginal bleeding between periods.

4.lower abdominal pain due to salpingitis(infected fallopian tubes)

Women with gonorrhea are at risk of developing serious complications from the infection.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements.
Most of the time rectal infection do not cause symptoms.

Infections in the throat may cause a sore throat.
Usually there are no symptoms.

How does gonorrhea affect a pregnant woman and her baby?
-----------------------------------------------------------------------

A pregnant woman with gonorrhea may give the infection to her baby as the baby passes through the birth canal during delivery.
This can cause blindness, joint infection, or a life-threatening blood infection in the baby.
Treatment of gonorrhea should be started as soon as it is detected in pregnant women.

How is gonorrhea diagnosed?
-----------------------------------

There are several laboratory tests available to diagnose gonorrhea:

1. a swab may be taken from cervix, urethra, rectum, or throat for testing

2. A direct Gram smear test of a sample from a urethra or a cervix allows the doctor in the clinic to see the gonorrhea bacterium under a microscope.

3. blood test can also detect the presence of gonorrhea in the blood stream

What is the treatment for gonorrhea?
--------------------------------------------

There are several antibiotics(penicillin, tetracyclines, spectinomycin) which can successfully cure gonorrhea in adolescents and adults.

Drug-resistant strains of gonorrhea are increasing in many areas of the world and successful treatment of gonorrhea is becoming more difficult.

Sometimes people with gonorrhea also have chlamydia.
Antibiotics for both infections are usually given together.

Persons with gonorrhea should be tested for other STDs.

It is advisable to take all of the medication prescribed to cure gonorrhea.
People who have had gonorrhea and have been treated can get the disease a second time if they have sexual contact with persons infected with gonorrhea.

What are the complications of gonorrhea?
--------------------------------------------------

Untreated gonorrhea can cause serious and permanent complications in both women and men.
In women, gonorrhea is a common cause of pelvic inflammatory disease (PID).
Women with PID may not have symptoms.
Symptoms when present can be very severe and can include abdominal pain and fever.
PID can cause internal abscesses in the pelvis which can give rise to long-lasting, chronic pelvic pain.
PID can damage the fallopian tubes enough to cause infertility and the risk of ectopic pregnancy.
Ectopic pregnancy is a life-threatening condition in which a fertilized egg grows outside the uterus, usually in a fallopian tube, sometimes in the abdomen.

In men gonorrhea can cause epididymitis, a painful infection of the testicles that can lead to infertility if left untreated.
Prostatits(infection of prostate), seminal vesiculitis and chronic urethral infection may be associated with fever and lead to urethral strictures causing difficulty in passing urine.

People with gonorrhea are more likely to contract HIV the virus that causes AIDS.

Gonorrhea can spread to the blood, joints or eyes(uveitis).
Blood infection or septicemia can be life threatening.

How can gonorrhea be prevented?
-----------------------------------------

The best way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse.
He or she should be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea.

Any genital symptoms such as discharge or burning sensation during urination or unusual sore or rash should be a signal to stop having sex.
A person who has been diagnosed and treated for gonorrhea should notify all recent sex partners so they can also be treated.
In this way there is less risk that the sexual partners will develop serious complications from gonorrhea.
It will also reduce the person's risk of becoming re-infected.
The person and all of his or her sex partners must avoid sex until they have completed their treatment for gonorrhea.

A Simple Guide to Ovarian Cancer

A Simple Guide to Ovarian Cancer
--------------

What is Ovarian Cancer?
----------------

Ovarian Cancer is a disease which cause abnormal cells in the ovary to proliferate and spread to the rest of the ovary or outside the ovary.

What are the different types of Ovarian Cancer?
-------------------------------------------------

Most experts group ovarian cancers within three major categories, according to the kind of cells from which they were formed:

1.epithelial tumors arise from cells that line or cover the ovaries;

2.germ cell tumors originate from cells that are destined to form eggs within the ovaries; and

3.sex cord-stromal cell tumors begin in the connective cells that hold the ovaries together and produce female hormones.

The most common type, the epithelial carcinoma, that begins from the surface of the ovary is discussed here.

Who is at risk of Ovarian Cancer?
---------------------------------------

The cause of cancer of the ovary is unknown.
However, studies show that certain factors may increase the chance of developing this disease. 1.family history of ovarian cancer.

2.history of cancer of the breast or colon.

3.age over 60 years.

4. Infertility or not having children. The more children you have, the lesser your risk is.

5.Early menstruation before the age of 12

6.late menopause

7.high fat diet

8.Use of fertility drugs, or Hormone Replacement Therapy (HRT).

Attempts are being made to detect early stages of ovarian cancer, especially among women who have an increased risk. A blood test is done to check for a substance called CA 125.
If the sample contains raised amounts of CA 125, an ultrasound scan may be done to see if your ovaries appear abnormal in any way.

What are the Symptoms of Ovarian Cancer?
---------------------------------------------------

Ovarian cancer is the most dangerous of gynaecological cancers because it is often silent and difficult to detect.There is no early detection method, so you must be vigilant and take note of persistent warning signs seriously.

If you are having some of the following symptoms persisting for more than a week or so, see your doctor.
1.Vague gastrointestinal symptoms such as gas, indigestion, nausea and a bloated feeling

2.Swelling in the abdomen, unexplained weight gain

3.Pelvic or abdominal pain or discomfort, and/or feeling of fullness

4.Urinary symptoms e.g. frequency and/or urgency of urination in the absence of an infection

5.Unexplained or changes in bowel habits

6.Loss of appetite/loss of weight

7.backache or pain inthe legs

8.Abnormal vaginal bleeding, although this is rare

If you do have any of the above symptoms you must have them checked by your doctor. Remember, they are non specific and most women with these symptoms will not have cancer.

How do you make the diagnosis of Ovarian Cancer?
-----------------------------------------------------------

If you are at risk of ovarian cancer, see your gynaecologist regularly.

The following may be done:
recto-vaginal bimanual pelvic exam,

Pap smear,

blood test for CA-125

transvaginal ultrasound

What are the treatment of Ovarian Cancer?
---------------------------------------------------

Treatment depends on a number of factors, including the stage of the disease (the extent of spread of the disease) and the general health of the patient.
Surgery, chemotherapy and various types of radiotherapy may be used alone, or in combination to treat ovarian cancer.

Surgery
Surgery is normally the first choice of treatment for ovarian cancer, and may sometimes also be needed to make the diagnosis. If detected is in the early stages, surgery is all the treatment that may be required. The ovaries, fallopian tubes, uterus and cervix are usually removed. The omentum and lymph nodes in the abdomen are often removed too.

If the surgeon feels the cancer may be difficult to remove, a few cycles of chemotherapy may be applied first and surgery carried out thereafter, in the hope that the tumour would have been reduced.

Chemotherapy
Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control cancer growth or to relieve symptoms of the disease. Sometimes a few cycles of chemotherapy may have to be applied before surgery is carried out.

Radiotherapy
Radiotherapy is less commonly used in this cancer but may sometimes be used to treat individual areas of cancer which have recurred after surgery and chemotherapy.

Hormone Therapy

There have been many reports of the potential benefits of hormone treatments in patients with ovarian cancer that does not respond to conventional therapy.

Some patients with treatment-resistant (refractory) epithelial cancers have been treated with:
1.progestins - crude forms of the female sex hormone progesterone;

2.estrogens - for example, diethylstilbestrol
3.combination estrogen/progestin therapy;
4.antiestrogens - tamoxifen;
5.androgens - male sex hormones for example, Halotestin
6.gonadotropin-releasing hormone (GnRH) - a hormone of the hypothalamus that stimulates the release of ovary-related hormones from the pituitary gland.

Gene Therapy

Gene therapy eventually may provide some control over cancer susceptibility and its treatment. Ovarian cancer, like all cancers, is believed to result from a build-up of genetic defects within the cells.Genetic engineers hope to correct such damage by transplanting copies of normal genes into cells with genetic defects. However at the moment gene therapy is still experimental.