1.
Curriculum Vitae
Nama : Brahmana Askandar
Pendidikan
S1 Kedokteran : FK Unair (1997)
Spesialis Obsgyn : FK Unair (2003)
Konsultan Onkologi : FK UI (2006)
Pendidikan Doktor : FK Unair (2015)
Pekerjaan / Jabatan
Ketua Divisi Onkologi, Dept Obgyn FK Unair / RSUD Dr. Sutomo Surabaya
Ketua POGI Surabaya
Pendidikan Tambahan
- Fellowship Gynecologic Surgery – St Stephen Hospital – Budapest – Hungaria - 2007
- Fellowship Gynecologic Endoscopy – New Delhi - India – 2008
- Fellowship Gyn Oncology – Universitar Medisch Centrum – Utrecht - Belanda - 2011
3.
“ An infection-induced inflammation of
the female upper reproductive tract (the
endometrium, fallopian tubes, ovaries, or
pelvic peritoneum)”
Definition
6.
Ascending infection from the cervix or vagina to the
endometrium, fallopian tubes, and adjacent
structures
More than 85% of infections are due to sexually
transmitted cervical pathogens or bacterial
vaginosis–associated microbes
PATHOPHYSIOLOGY
7.
Ascending infection from the cervix is often due to
sexually acquired infections with N. gonorrhoeae or
C. trachomatis
5% of untreated chlamydial infections progress to
clinically diagnosed pelvic inflammatory disease
8.
Pelvic / lower abdominal pain
Abnormal vaginal discharge
Dyspareneuia
Dysuria
+ Demam
Cervical motion tenderness, adnexal tenderness, or
uterine compression tenderness on bimanual
examination
Pelvic tenderness of any kind has high sensitivity
(>95%) for pelvic inflammatory disease, but it has
poor specificity
Clinical Manifestation
9.
Subclinical pelvic inflammatory disease : no symptoms
Tubal factor infertility serologi C. trachomatis dan N.
Gonorhoe positif
Clinical Manifestation
10.
Can be symptomatic or asymptomatic
Lower abdominal pain which is typically bilateral
Fever (> 38 degree)
Deep dyspareunia
Chronic pelvic pain
Abnormal vaginal bleeding- post-coital bleed, inter-
menstrual bleed, menorrhagia
Abnormal vaginal or cervical discharge- which is
often purulent
Symptoms
14.
All patients with suspected pelvic inflammatory disease
should undergo cervical or vaginal nucleic acid
amplification tests for N. gonorrhoeae and C. trachomatis
infection
Blood test
Vaginal swab and sensitivity test
Ultrasound abcess?
Laparoscopy if necessary
Workup
15.
Oral temperature >101° F (>38.3° C);
Abnormal cervical or vaginal mucopurulent
discharge
Presence of abundant numbers of WBC on vaginal
fluid
Elevated LED
Elevated C-reactive protein
Laboratory documentation of cervical infection with
N. gonorrhoeae or C. trachomatis.
Criterias to Support Dignosis
(CDC)
16.
The most specific criteria for diagnosing PID include:
endometrial biopsy with histopathologic evidence of
endometritis
transvaginal sonography or magnetic resonance
imaging techniques showing thickened, fluid-filled
tubes with or without free pelvic fluid or tubo-
ovarian complex, or Doppler studies suggesting
pelvic infection (e.g., tubal hyperemia)
laparoscopic abnormalities consistent with PID.
19.
Surgical emergencies (e.g., appendicitis) cannot be
excluded
The patient is pregnant
The patient does not respond clinically to oral
antimicrobial therapy
The patient is unable to follow or tolerate an
outpatient oral regimen
The patient has severe illness, nausea and vomiting,
or high fever
The patient has a tubo-ovarian abscess.
Hospitalisation Criterias
22.
CDC USA Annual test for C. Trachomatis and N.
Gonorhoe
- Sexually active women <25 years old
- High risk older woman
Sex education
Single sexual partner
Prevention
23.
The American Congress of Obstetricians and Gynecologists
recommends screening for chlamydia and gonorrhea in :
- sexually active females aged 25 years or younger.
- women older than 25 years who have risk factors
Screening for CT and NG
24.
Final Recommendation Statement
Gonorrhea and Chlamydia: Screening, September 2014
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and
Quality or the U.S. Department of Health and Human Services.
Recommendation Summary
Preface
Rationale
Clinical Considerations
Other Considerations
Discussion
Update of Previous USPSTF Recommendations
Recommendations of Others
Members of the U.S. Preventive Services Task Force
References
Copyright and Source Information
Table of Contents
Recommendation Summary
Summary of Recommendations and Evidence
Population Recommendation
Grade
(What's This?)
Sexually Active Women
The USPSTF recommends screening for chlamydia in sexually active women age 24 years and
younger and in older women who are at increased risk for infection.
Sexually Active Women
The USPSTF recommends screening for gonorrhea in sexually active women age 24 years and
younger and in older women who are at increased risk for infection.
Sexually Active Men
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and
harms of screening for chlamydia and gonorrhea in men.
Go to the Clinical Considerations section for a description of populations at increased risk for infection and for suggestions for practice
regarding the I statement.
Preface
Release Date: September 23, 2014
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific clinical preventive services for patients without related signs or
symptoms.
It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of
providing a service in this assessment.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to
the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.
This article was published online first at www.annals.org on September 23, 2014. Select for copyright and source information.
USPSTF Recommendation
US Preventive Services Task Force
25.
Culture
Serology for CT (not for N. Gonorhoe)
Nucleic acid amplification Test
Test For CT / NG
26.
Recommended Regimens
Azithromycin 1 g orally in a single dose
OR Doxycycline 100 mg orally twice a day for 7 days
Alternative Regimens
Erythromycin base 500 mg orally four times a day for 7
days
OR Erythromycin ethylsuccinate 800 mg orally four times
a day for 7 days
OR Levofloxacin 500 mg orally once daily for 7 days
OR Ofloxacin 300 mg orally twice a day for 7 days
If Test Positive
