Greater Risk of Developing PID Essay

Greater Risk of Developing PID Essay

Greater Risk of Developing PID Essay

Make a comment using your own words in each discussion but please provide at least one reference for each comment.

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Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.

Provide the comment for each discussion separate.Greater Risk of Developing PID Essay

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While interviewing this patient, we must ask many questions in order to fully evaluate and assess her symptoms in order to proceed with the appropriate action. The patient Kayla comes in today with pain in her lower left abdomen, near her pelvic area. We must get a comprehensive history and physical, as well as sexual history on Kayla as she is experiencing severe pain in her abdomen. We must ask Kayla:
• Where exactly is the pain located?
• How long have you been experiencing this pain?
• Does it get better or worse with certain movements or other interventions?
• Have you taken any medication for the pain and has it helped your symptoms?
• Are you sexually active?
• Do you and your partner use any method of birth control?
• Is there a chance you could be pregnant?
• Have you been tested for STD/STIs?
• What does your gynecological history consist of?
• Have you ever had symptoms like this before?
• Are you having any vaginal discharge?
Clinical findings that may be present in a patient with this condition would be sudden and intensely severe pain, in addition to nausea and vomiting. Usually in a patient with this condition, the patient experiences cramps for several days up to weeks leading up to the intense sharp pains. Ovarian torsion can also cause peritonitis within the abdominal cavity, causing more overlying abdominal discomfort and pains. Ovarian torsion is considered a medical emergency. If no action is taken, the ovary can lose blood supply and become necrotic, greatly impacting fertility and potentially rendering the ovary non-salvageable. Greater Risk of Developing PID Essay
Diagnostic studies for ovarian torsion typically involves the provider gathering information based upon the patient’s symptoms as well as physical exam. A physical exam would display the patient having severe pelvic pain, typically unilateral in nature. The affected side is typically palpable during an abdominal examination. At this point, an ultrasound is another diagnostic tool that is used to diagnose ovarian torsion. In this diagnostic test, a probe is inserted into the vagina which transmits sound waves to create images of internal structures such as the cervix, uterus, ovaries, tubes, and pelvic area. If ovarian torsion is confirmed with this examination, the patient must have laparoscopic surgery to untwist the ovary (Hawkins, J., Roberto-Nicholas,D. & Stanley-Haney, J. (2016).
The primary diagnosis for this patient is ovarian torsion. We know a woman who is experiencing severe, sudden, and intense pain in her pelvic area is presenting with all of the symptoms of ovarian torsion. Additionally, this diagnosis is especially appropriate when the patient is experiencing nausea and vomiting. This patient is also of reproductive age, which makes this a common diagnosis. Greater Risk of Developing PID Essay
A differential diagnosis for this patient would be pelvic inflammatory disease, which was actually this patient’s initial diagnosis. Pelvic inflammatory disease is caused by an infection of the female reproductive system. Usually this condition occurs when a patient has had a history of STDs that may not have been treated. Women who are sexually active and are under the age of 25 are also at greater risk for PID. Douching and having an IUD place you at greater risk of developing PID as well (Schuiling, K. D. & Likis, F. E. (2016).
Another differential diagnosis for this patient would be a ruptured ovarian cyst. A ruptured ovarian cyst presents many similar symptoms to ovarian torsion. An ovarian cyst is a fluid filled sac on the ovary. These cysts can cause pelvic cramping every so often, causing a patient pain and discomfort. When one of these cysts ruptures, the patient will experience severe pain in the lower abdomen, and may even have internal bleeding. If severe, the patient may need to go to the hospital for IV fluids, pain management, and in rare cases, surgical intervention may be necessary.
The last differential diagnosis for this patient would be an ectopic pregnancy. We know this patient is sexually active, so an ectopic pregnancy could be a possibility. When a woman is experiencing an ectopic pregnancy, she will have sharp pain and abdominal cramps as well as nausea and vomiting. An ectopic pregnancy can be extremely dangerous as it could cause the fallopian tube to rupture or burst.
Management for this patient post surgically will involve her plan for recovery after her surgery and management of pain. She may need ibuprofen scheduled for pain management over the next following weeks. Her CBC, CMP, and urinalysis should be checked over the next following weeks to ensure she does not develop an infection, and that her blood levels remain adequate. She will require a great deal of education regarding her fertility status in the future, birth control methods available to her, and risk factors for developing pelvic infections since she just had surgery. The patient should know that she can still get pregnant even though she now only has one ovary. I would likely not recommend this patient utilize IUDs as a method of birth control given that she is placed at greater risk for pelvic infections now, and that she is only 16 and this will not protect her from STDs.Greater Risk of Developing PID Essay

Discussion #2

For a patient who presents with probable PID, there are several questions that should be asked of the patient. First I would begin by asking about her symptoms and when they began. Is she experiencing pain? If so, where is the pain located, how would she describe it, and what has she tried for pain relief since the symptoms began. I would ask about age of onset of menses, how her cycles typically are such as length, symptoms, flow, etc. Because one of the characteristic symptoms of PID is abrupt onset of lower abdominal pain immediately following menses, I would ask about her most recent cycle. Has the patient experienced any other symptoms such as nausea, vomiting, fever, back ache, burning or burning on urination, bleeding, vaginal discharge, odor or itching. I would also question whether the pain is exacerbated by movement Valsalva, palpation or sex. It is important to know if the patient is sexually active, uses condoms if so, and any history of STIs. Has the patient had any significant gynecological history such as ovarian cysts that could also be a source of her acute pain? A patient with PID will typically present with an acute lower abdominal pain, usually bilaterally, that began immediately after menses. The pain can be described anywhere from intense, throbbing or radiating to even mild for some patients. Many patients will also report symptoms such as irregular vaginal discharge, spotting between menses, nausea, vomiting, fever, pelvic and low back pain (Schooling & Likis, 2017).
Diagnosing PID should include drawing labs such as CBC, CMP, ESR, C reactive protein, and full STD panel. The patient should also have bacterial swabs sent for review, a urinalysis and culture. Vaginal fluid may show an increased number of white blood cells on saline microscopy. I would also want an abdominal ultrasound to rule out any other differential diagnoses such as ovarian cysts, ovarian torsion, ectopic pregnancy, endometriosis, IBD and appendicitis. Endometrial biopsy with histopatholigical evidence of endometriosis, transvaginal ultrasound, MRI and laproscopy are the other diagnostic tests that can diagnose PID (Schooling & Likis, 2017). Greater Risk of Developing PID Essay
In the case of this patient, the primary diagnosis was PID, however the differentials should have included ovarian cyst with torsion, ectopic pregnancy and endometriosis. It would also be imperative to rule out appendicitis with the acute onset and location of her pain. All of these include acute abdominal pain in the lower quadrants and should be evaluated in the female patient. Because the patient is sexually active, it is important to rule out ectopic pregnancy. Although the patient has not had a history of ovarian cysts, because of the detrimental outcome of an untreated cyst with torsion, it is also extremely important to rule this out as well before coming to a conclusion of PID (Schooling & Likis, 2017).

Treatment of PID includes oral antibiotics if the patient can tolerate or is safe for home treatment, or inpatient treatment with IV antibiotics. The gold standard treatment for PID is Ceftriaxone 250mg IM one time plus doxycycline 100mg orally 2 times a day for 14 days with or without flagyl 500mg orally 2 times a day for 14 days. The patient with this regimen should be educated on the importance of finishing the whole treatment and not drinking while on flagyl. The patient should abstain from sexual intercourse until treatment is completed, symptoms are resolved and the partner has been adequately treated as well. Male partners within the last 60 days should be treated (Schooling & Likis, 2017).Greater Risk of Developing PID Essay

Pelvic inflammatory disease (PID) is the clinical syndrome resulting from ascending infection from the lower genital tract to involve the endometrium, Fallopian tubes and/or adjacent pelvic structures.1 Consequences of infection include tubal infertility, ectopic pregnancy, and chronic pelvic pain.2 The severity of the sequelae in conjunction with the relatively high incidence of PID in some communities invoke costly consequences at the level of personal and public health.3–5

Diagnosis of PID is often difficult. The “gold standard” for diagnosis relies on the laparoscopic appearance of Fallopian tube inflammation6 but cost and limited availability of the technique often preclude its use. In the absence of laparoscopy, the triad of lower abdominal pain, cervical motion tenderness, and bilateral adnexal tenderness has been advocated as the minimal criterion for clinical diagnosis of PID.7 However, many cases of PID are asymptomatic or present with minimal or atypical symptoms.1 This means that diagnosing PID on purely clinical grounds is often difficult and the margin for error is wide.8 In this context, knowledge of risk factors and markers for PID could substantially aid diagnosis. Although multiple organisms have been implicated in the pathogenesis of PID,9,10 chlamydial and gonococcal infections account for the majority of infections.1 Thus, risk assessment in individual patients has relied on estimation of the likelihood of exposure to a sexually transmitted infection (STI).Greater Risk of Developing PID Essay

Previous studies have linked a wide range of interrelated risk factors (direct causal association)/or markers (indirect relation) to the acquisition of PID. In general, presence of an STI and the use of intrauterine contraceptive devices (IUCDs) have been consistently reported as risk factors, whereas previous PID, previous gonorrhoea, young age, and multiple sexual partners have been reported as risk markers.11–15

The objectives of this study were to identify sexual, social, and demographic risk factors for the acquisition of PID diagnosed presumptively in women attending a sexual health service and on the basis of these findings to formulate health promotion recommendations to reduce the incidence and consequences of PID.

Subjects and methods
Cases were all women who attended the Sydney Sexual Health Centre (SSHC), a public sexual health service in the central business district of the city between 1 April 1991 and 31 December 1997, who were newly diagnosed as having “presumptive” PID by clinic medical personnel. Cases were derived from the clinic database on the basis of a diagnosis of presumptive PID. Controls were women who attended the clinic over the same period who were not diagnosed as having PID. Controls were matched with cases in a one to one ratio by day of attendance—usually the next registered patient. Controls also were derived from the clinic database.Greater Risk of Developing PID Essay

Data were recorded at the time of presentation using a standardised medical record form and then entered onto the clinic database. Analysis was performed retrospectively. Variables analysed in the study included age; country of birth; whether English was spoken at home; whether they currently were in a sexual relationship; condom use with non-paying partners; lifetime number of opposite sex partners; whether they had ever had sex with a homosexual or bisexual male, an injecting drug user, a male with multiple previous sexual partners, or a person from outside Australia; contraception; pregnancy history; previous termination(s) of pregnancy or miscarriage; cigarette smoking; alcohol consumption; and history of previous gonorrhoea, syphilis, chlamydia, PID, genital herpes, genital warts, bacterial vaginosis, candidiasis, trichomoniasis, and urinary tract infections. The history of STIs included all infections diagnosed up to and including the day of diagnosis. Continuous variables, such as age were treated as categorical variables by grouping. Comparisons were made using χ2 tests for categorical variables, Student’s t test, and Fisher’s exact test as appropriate. Crude odds ratios (OR) with their 95% confidence interval (CI) were calculated using univariate analysis. Factors which were related to a diagnosis of PID on univariate analysis (p<0.10) and factors considered possibly to be of clinical importance were further analysed using unconditional logistic regression models to permit statistical control of confounding variables. Variables with more than 10% missing data were considered unreliable and excluded from the multivariate analysis. Analysis was performed using the SPSS16 and SAS17 statistical packages.Greater Risk of Developing PID Essay

The study was approved by South Eastern Sydney Area Health Service research ethics committee.

Results
Seven hundred and forty one patients with presumptive PID were identified together with an equal number of controls. Table 1 shows the social history comparing patients and controls. Patients with PID were significantly younger than controls with 73% under 30 years of age compared with 49% of the controls (p<0.001). There were marked differences comparing country of birth in the two groups with two thirds of controls being born in Australia or New Zealand compared with 42% of cases. An additional 42% of cases were born in north or South East Asia, compared with 12% of the controls (p<0.001). Finally, cases were more likely to smoke than controls (46% v 36%, p<0.001).

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Table 1
Social history comparing cases and controls

Table 2 shows the obstetric and co

Teenage girls with pelvic inflammatory disease (PID) are more likely than adult women to have repeated sexually transmitted infections shortly after the initial diagnosis and to develop recurrent PID sooner, according to a new study from Johns Hopkins Children’s Center and other institutions.Greater Risk of Developing PID Essay

Because recurrent STI infections and PID compound a girl’s long-term risk for chronic pelvic pain and infertility, these findings emphasize the need for more aggressive prevention, counseling and treatment of teenagers with PID, the investigators write in the January issue of Archives of Pediatrics & Adolescent Medicine.

The research team analyzed 831 patient records of women, ages 14 to 38, treated for mild and moderate PID in eight hospitals across the United States. The study compared subsequent infections, chronic pelvic pain, pregnancy and infertility between girls (19 years and younger) and women.

At the three-year follow-up, 17 percent of teenage girls reported having another PID episode, compared to less than 14 percent of adult women. At the seven-year checkup, one in four girls reported second PID compared to one in five adult women.

Teens were more likely to test positive for gonorrhea or Chlamydia at the time of the diagnosis (63 percent vs. 41 percent) and 30 days after the diagnosis (20 percent vs. 5.2 percent).

The girls’ higher infection rates also appear to contradict their claims of using condoms more consistently than adult women and suggest that they may over-report safe-sex practices.Greater Risk of Developing PID Essay

PID, an inflammation of the reproductive organs, is a complication of untreated sexually transmitted infections like Chlamydia and gonorrhea, among other bacterial infections, and affects more than 1 million women in the United States each year, according to the U.S. Centers for Disease Control. More than 100,000 of these women develop fertility problems as a result of their infections.

“Right now we are treating teenage girls and adult women with PID in the exact same way but we really shouldn’t,” says lead researcher Maria Trent, M.D., M.P.H., a pediatrician and adolescent medicine specialist at Hopkins Children’s. “Psychological and social dynamics typical of adolescence may explain some of the differences in infection rates, and we need to factor them into the way we design prevention and treatment.”

For example, the researchers say, teenagers tend to change partners more often than adult women, a pattern that increases teen girls’ STI risk.
Patients with moderate and mild disease are sent home with a course of antibiotics and asked to return for a check-up in 72 hours. However, in light of the new findings, the researchers say, a more structured and vigilant approach is needed with rigorous follow-up and closer monitoring of a “vulnerable population.”Greater Risk of Developing PID Essay

Regardless of age, many of the women in the study suffered significant consequences, such as chronic abdominal pain and infertility. Indeed, the analysis found no difference in these outcomes between the age groups at three-year and seven-year follow-ups. Overall, nearly one in five of all patients experienced fertility problems and 40 percent reported chronic pelvic pain, both “alarming findings,” the researchers say, given that none of the patients in the study had experienced severe PID.

At the three-year follow-up, 44 percent of patients had chronic abdominal pain, 22 percent were infertile, 41 percent became pregnant and 14 percent had another episode of PID. At the seven-year mark, 41 percent reported chronic abdominal pain, 18 percent were categorized as infertile, 57 percent got pregnant and 20 percent had another PID episode.

The researchers say that even though the majority of those in the study were low-income African-American females, the findings shed light on important age differences that likely hold true across the board. African-American women also are disproportionately affected by PID and infertility, the researchers say. Greater Risk of Developing PID Essay

 

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