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er genital tract infections (UGTI)
Upper genital tract infections (UGTI)
U pper g enital tract infections are bacterial infections of th e uterus (end om etritis)
and /or th e fallopian tubes (salping itis), w h ich m ay be com plicated by peritonitis,
pelv ic abscess or septicaem ia.
U GT I m ay be sexually transm itted or arise after ch ild birth or abortion. Antibiotic
ch oices are d irected by th e m ost com m on path og ens in each scenario.
If peritonitis or pelv ic abscess is suspected , request a surg ical opinion wh ile initiating
antibiotic th erapy.
Clinical features
Sexually transmitted infections
Diag nosis m ay be d ifficult, as clinical presentation is v ariable.
– S ug g estiv e sym ptom s are: abd om inal pain, abnorm al v ag inal d isch arg e, fev er,
d yspareunia, m enom etrorrh ag ia, d ysuria.
– Infection is probable wh en one or m ore of th e abov e sym ptom s are associated w ith
one or m ore of th e following sig ns: cerv ical m otion tend erness, ad nexal tend erness,
tend er abd om inal m ass.
Infections after childbirth or abortion
– M ost cases present with a typical clinical picture, d ev eloping with in 2 to 10 d ays after
d eliv ery (caesarean section or v ag inal d eliv ery) or abortion (spontaneous or ind uced ):
• Fev er, g enerally h ig h
• Abd om inal or pelv ic pain
• M alod orous or purulent loch ia
• E nlarg ed , soft and /or tend er uterus
– Ch eck for retained placenta.
– In th e early stag es, fev er m ay be absent or m od erate and abd om inal pain m ay be
m ild .
Treatment
– Criteria for h ospitalisation includ e:
• Clinical suspicion of sev ere or com plicated infection (e.g . peritonitis, abscess,
septicaem ia)
• Diag nostic uncertainty (e.g . suspicion of extra-uterine preg nancy, append icitis)
• S ig nificant obstacles to am bulatory oral treatm ent
• N o im prov em ent after 48 h ours, or d eterioration w ith in 48 h ours, of outpatient
treatm ent
– All oth er patients m ay be treated on an am bulatory basis. T h ey sh ould be reassessed
routinely on th e th ird d ay of treatm ent to ev aluate clinical im prov em ent (d ecrease in
pain, absence of fev er). If it is d ifficult to org anise routine follow-up, ad v ise patients
to return to clinic if th ere is no im prov em ent after 48 h ours of treatm ent, or sooner if
th eir cond ition is worsening .
240
Upper genital tract infections (UGTI)
U pper g enital tract infections are bacterial infections of th e uterus (end om etritis)
and /or th e fallopian tubes (salping itis), w h ich m ay be com plicated by peritonitis,
pelv ic abscess or septicaem ia.
U GT I m ay be sexually transm itted or arise after ch ild birth or abortion. Antibiotic
ch oices are d irected by th e m ost com m on path og ens in each scenario.
If peritonitis or pelv ic abscess is suspected , request a surg ical opinion wh ile initiating
antibiotic th erapy.
Clinical features
Sexually transmitted infections
Diag nosis m ay be d ifficult, as clinical presentation is v ariable.
– S ug g estiv e sym ptom s are: abd om inal pain, abnorm al v ag inal d isch arg e, fev er,
d yspareunia, m enom etrorrh ag ia, d ysuria.
– Infection is probable wh en one or m ore of th e abov e sym ptom s are associated w ith
one or m ore of th e following sig ns: cerv ical m otion tend erness, ad nexal tend erness,
tend er abd om inal m ass.
Infections after childbirth or abortion
– M ost cases present with a typical clinical picture, d ev eloping with in 2 to 10 d ays after
d eliv ery (caesarean section or v ag inal d eliv ery) or abortion (spontaneous or ind uced ):
• Fev er, g enerally h ig h
• Abd om inal or pelv ic pain
• M alod orous or purulent loch ia
• E nlarg ed , soft and /or tend er uterus
– Ch eck for retained placenta.
– In th e early stag es, fev er m ay be absent or m od erate and abd om inal pain m ay be
m ild .
Treatment
– Criteria for h ospitalisation includ e:
• Clinical suspicion of sev ere or com plicated infection (e.g . peritonitis, abscess,
septicaem ia)
• Diag nostic uncertainty (e.g . suspicion of extra-uterine preg nancy, append icitis)
• S ig nificant obstacles to am bulatory oral treatm ent
• N o im prov em ent after 48 h ours, or d eterioration w ith in 48 h ours, of outpatient
treatm ent
– All oth er patients m ay be treated on an am bulatory basis. T h ey sh ould be reassessed
routinely on th e th ird d ay of treatm ent to ev aluate clinical im prov em ent (d ecrease in
pain, absence of fev er). If it is d ifficult to org anise routine follow-up, ad v ise patients
to return to clinic if th ere is no im prov em ent after 48 h ours of treatm ent, or sooner if
th eir cond ition is worsening .
240
