Reproductive Tract Infections & Pelvic Inflammatory Diseases

Sub: Reproductive Health
Unit: II Reproductive Disorders

Topic: Reproductive Tract Infection (RTIs) &
Pelvic Inflammatory Diseases (PID)
Lect: --
Faculty: Ms. Almas Ghaffar (Asso. Professor)

MSN, BSN, RN, RM,
PNS,LUMHS, Jamshoro
Date: --/--/14 1
Reproductive Tract Infections
• Reproductive Tract Infections(RTIs)refer to three different
types of infection which affect the reproductive tract,
namely endogenous, iatrogenic and sexually transmitted
infections, including HIV/AIDS.
• Endogenous Infections are probably the most common
RTIs worldwide.
• Iatrogenic Infections occur when the cause of infection,
i.e., a bacterium or other micro-organism, is introduced
into the reproductive tract through a medical procedure
such as menstrual regulation, induced abortion.
• Use of unsterilized instruments
Endogenous Infections
Causes
• Overgrowth of organisms normally present in the
vagina.
• Endogenous infections include bacterial vaginosis and
candidiasis.
Iatrogenic Infections:
Causes
• Bacterium or other micro-organism, is introduced into the
reproductive tract through a medical procedure i.e. menstrual
regulation, induced abortion, the insertion of an IUD or
during childbirth.
STIs
• Sexually Transmitted Infections are caused by viruses,
bacteria, or parasitic micro-organisms that are
transmitted through sexual activity with an infected
partner.
• Reproductive Tract Infections:

A. Syphilis and Chancroid
B. Gonorrhea and Chlamydia
C. Vaginitis and Cervicitis
D. Pelvic Inflammatory Disease
Syphilis
• It is considered as highly infectious, systamic STD.
• Transmitted by blood transfusion.
• Syphilis is a known cofactor for development of HIV.
Cause: bacterium called Treponema pallidum..
Sign and symptoms:
• Rash on body Disease may damage brain,
• Muscle aches nerves, eyes, heart, blood
• Fever vessels, liver, bones and
• Sore throat and joints
• Swollen lymph nodes
Cont…
Risk Factors Complications
• Unprotected sex • Stroke
• Sex with multiple partners • Meningitis

• Deafness
• Man who has sex with men
• Visual problems
• Infected with HIV, the
• Dementia
virus that causes AIDS
• Aneurysm
• Inflammation of the aorta
• Risk of miscarriage
• Stillbirth or neonatal death
Diagnosis
• CBC
• Analysis of fluid from sores
• Cerebral spinal fluid test.
Treatment:
• Penicillin
• Doxycycline
• Tetracycline
Chancroid
• Chancroid (SHANG-kroid) is a type of bacteria that is
transmitted through sexual contact.
Cause: Gr-ve bacillus hemophilus ducreyi
Sign and symptoms:
• Open sores, usually on the penis, rectum, and vulva —
especially around the opening to the vagina.
• Sores may produce pus and be painful.
• Swollen glands in the groin.
Cont…
Diagnosis Treatment
• Examination of discharge • Antibiotics i.e.
from sore – Ciprofloxacin
– Erythromycin
– Azithromycin
• Also treat the partner at
the same time.
Gonorrhea
• Also called the "clap" or "drip," gonorrhea is a
contagious disease transmitted most often through
sexual contact with an infected person.
• Both men and women can get gonorrhea
Cause: a bacterium called Neisseria gonorrhoeae

Sign & Symptom
In Women
In Men
• Greenish yellow or whitish • Greenish yellow or
discharge from the vagina whitish discharge from
• Lower abdominal or pelvic pain the penis
• Burning when urinating • Burning when urinating
• Conjunctivitis (red, itchy eyes) • Painful or swollen

testicles
• Bleeding between periods
• Spotting after intercourse
• Swelling of the vulva (vulvitis)
Cont….
Diagnosis Complications
• Gram Stain
• Culture • Sulpinigitis
• Epididymitis
Treatment:
• Penicillin • Prostatitis’
• Ceftriaxone • Infertility
• Ciproflaxcin • PID
•
Chlamydia
• Chlamydia is a common sexually transmitted infection
in humans.
• The term Chlamydia infection can also refer to
infection caused by any species belonging to the
bacterial family Chlamydiaceae.
Cause: Chlamydia trachomatis

Sign & Symptom
In Women
In Men
• Abnormal vaginal discharge • Small amounts of clear or
that may have an odor cloudy discharge from the
• Bleeding between periods tip of the penis
• Painful periods • Painful urination
• Abdominal pain with fever • Burning and itching

around the opening of the
• Pain when having sex penis
• Itching or burning in or • Pain and swelling around
around the vagina the testicles
• Pain when urinating
Cont….
In women
• Swab from urethra in • PID
men & from cervix in • Infertility
women for analysis • Ectopic pregnancy
• Urine analysis • Premature birth
• Infertility
Treatment: Antibiotics
• Eye infection, blindness, or
• Doxycycline pneumonia in the newborn.
• Azithromycin • In Men
• Infection of the urethra
• Epididymitis
Vaginitis
Infection or inflammation of vagina .
Causes Sign & Symptoms
• Trichomonas or Candida • Change in color, odor or
species. amount of discharge from
• Vaginitis can also result vagina
from reduced estrogen • Vaginal itching or irritation
levels after menopause. • Pain during intercourse
• Painful urination
• Light vaginal bleeding or
spotting
Cont….
• History: history of
vaginal or sexually • Premature deliveries
transmitted infections • Low birth weight babies
• Pelvic exam
• Risk of acquiring HIV
• Sample of cervical or
and other sexually
vaginal discharge for transmitted infections.
lab test
Treatment: Antibiotics
• Nystatin
• Metronidazole
Cervicitis

Inflammation of the cervix.
Cervicitis is a more severe disease than vaginitis.
Causes Sign & Symptoms
• STIs • Grayish or yellow and pus-like
vaginal discharge sometimes
• Allergic reactions i.e. has an unpleasant odor
contraceptive
• Frequent, painful urination
• Bacterial overgrowth • Pain during intercourse
• Vaginal bleeding after
intercourse, between menstrual
periods or after menopause
Cont….
• History • Cervicitis that's caused
• Pelvic exam by gonorrhea or
chlamydia can spread to
• Cervical and vaginal
the uterine lining and
fluid for lab test the fallopian tubes.
• Urine DR
• Resulting in PID
Treatment: Antibiotics • Untreated PID can cause
• Ceftriaxone fertility problems.
• Azithromycin
• Doxycycline
Specific Nursing Management Of RTI
• Eradicate the disease and manifestation
• Provide the psychological support.
• Administer prescribed medication
• Treat infection
• Monitor serologic test value sex.
• Educate to avoided the transmission of disease.
• Prevention and control of disease
• Proper follow up.
• Educate to both sexual partner about
Pelvic Inflammatory Disease
Definition
• Pelvic inflammatory disease (PID) is an
inflammatory condition of the pelvic cavity that may
begin with cervicitis and may involve the uterus
(endometritis), fallopian tubes (salpingitis), ovaries
(oophoritis), pelvic peritoneum, or pelvic vascular
system.
• Infection, which may be acute, subacute, recurrent, or

chronic and localized or widespread,
Causes
• Usually caused by:
• Bacteria but may be attributed to a
• Virus
• Fungus or
• Parasite
• Gonorrheal and
• Chlamydial organisms are the most likely causes
Signs & Symptoms
• Lower abdominal pelvic pain, and tenderness that occurs after
menses
• Pain may increase while voiding or with defecation.
• Cervical motion tenderness (pain on movement of the cervix).
• Fever
• Vaginal discharge
• Dyspareunia (pain during intercourse)
• General malaise
• Anorexia
• Nausea, headache, and possibly vomiting.
Complications
• Pelvic or generalized peritonitis.
• Abscesses
• Strictures, and
• Fallopian tube obstruction
• Obstruction may cause an ectopic pregnancy in the
future.
• Sterility.
• Bacteremia with septic shock
• Thrombophlebitis with possible embolization.
Diagnosis
• CBC will show an elevated WBC
• Pregnancy test—beta hCG
• Chlamydia test
• Gonorrhea test
• Venereal Disease Research Laboratory (VDRL) test for
syphilis
• Rapid Plasma Reagin (RPR) test for syphilis
• Fluorescent Treponema Antibody (FTA–ABS) test used to
confirm syphilis
• Chandelier sign—a great amount of pain is elicited when the
cervix is touched (the woman will jump to the chandelier)
Medical Management
• Broad-spectrum antibiotic therapy.
• Mild infections may be treated as outpatients
• In hospitalization intensive therapy includes:
• Bed rest
• I/V fluids, and
• I/V antibiotic
• Nasogastric intubation and suction are initiated if abdominal
distention or ileus present.
• Monitor vital sign
• Treatment of sexual partners is necessary to prevent
infection
Nursing Management
• General nursing management:
 To take the history
 Monitor vital sign
 Provide the education about hygiene.
 Advice about nutrition
• Teach patient about:
– Spread of the disease.
– Practicing safe sex.
– Medication use and side effects.
– Necessity of treating all partners.
References
• Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever.

K. H. (2011). Textbook of Medical – Surgical
Nursing. Vol -I (12th Ed.). Wolters Kluwer. New
Delhi.
• http://www.mayoclinic.org

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Sub: Reproductive Health

Unit: II Reproductive Disorders

Faculty: Ms. Almas Ghaffar (Asso. Professor)

• Reproductive Tract Infections:

• Unprotected sex • Stroke

• Sex with multiple partners • Meningitis

Cause: a bacterium called Neisseria gonorrhoeae

• Burning when urinating • Burning when urinating

• Conjunctivitis (red, itchy eyes) • Painful or swollen

Cause: Chlamydia trachomatis

• Painful periods • Painful urination

• Abdominal pain with fever • Burning and itching

• Infection, which may be acute, subacute, recurrent, or

• Smeltzer. S. C., Bare. B.G., Hinkle. J. L & Cheever.

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