Infection pelvienne [ Publications ]

infection pelvienne [ Publications ]

Publications > infection pelvienne

  • Although sexually transmitted diseases are a major public health problem at the international level, the relationship between contraception and pelvic infection is seldom examined. Numerous STDs are more difficult to diagnose, more frequent, and more serious in women than in men. Differential diagnosis between pelvic infection and other intraabdominal syndromes has been a concern for practitioners for years, and many pelvic infections are probably never diagnosed. Lower abdominal pain and sensitivity as well as fever, leucocytosis, accelerated sedimentation rate, inflammatory annexial mass evident on sonography, and microorganisms in the pouch of Douglass and presence of leucocytes in the peritoneal fluid are diagnostic criteria. Apart from errors in treatment resulting from errors in diagnosis, pelvic infections are often inadequately treated, especially in the initial phase before symptoms are confirmed. The exact incidence of pelvic infections in the US is unknown, but pelvic inflammatory disease (PID) accounted for over 200,000 hospitalizations per year between 1970-75. PID carries grave risks of subsequent ectopic pregnancy, chronic pelvic pain, and infertility which is more likely as the number of acute episodes increases. The female genital tract has diverse microenvironments propitious for growth of microorganisms of different types, aerobic and anaerobic. Each anatomic site has specific features conditioning bacterial growth. Histological modifications during the menstrual cycle and pregnancy affect the microbial flora. Except in the case of gonorrhea, it is not known how many female lower genital tract infections spread to the upper tract. Since 1970, several studies have domonstrated a growing diversity of cervical and vaginal flora in asymptomatic subjects. The principal risk factors for PID have been well described in the literature. All contraceptive methods except the IUD provide some degree of protection against PID. Even among IUD users the risk of PID is probably not greater than among women with a comparable risk of exposure to STDs. The protective effect of condoms has been recognized since the era of Casanova, but it is difficult to quantify. Studies describing the protective effects of spermicides used one against pelvic infection are very rare, and protective effects have usually been demonstrated only in vitro. Surfactants such as nonoxynol probably have viricidal properties against herpes simplex. Condoms and diaphragms have been seen to exercise a protective effect independent of spermicide, with relative risks of .6 and .4 compared to nonouse of contraception. There is as yet no consensus on changes in risk of PID during oral contraceptive (OC) use, but several studies have shown OCs to have a protective effect. Risks of PID in IUD users apparently stem from contamination during insertion or of the thread during prolonged use, but both possibilities remain controversial. The use of women not using contraception as controls in studies of relative risks of PId may not be appropriate because their sexual behavior and risks of exposure to STDs may differ. At the moment of ovulation, when the mucus is most receptive, IUDs do not place any barrier in the way of ascension of sperm and bacteria to the upper genital tract.

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Sterilet et infection pelvienne: etude clini ue comparee au Danemark, en Finlande et en Suede, de deux sterilets liberant du cuivre: NOVA T et TCu 200.

  • 2 intrauterine devices, Copper-T-200 and a new type, Nova-T, were compared in a study conducted simultaneously in Denmark, Finland and Sweden over a period of 1 year. The results obtained were very similar with the exception of the pregnancy rate which is 3 times lower with Nova-T than with Copper-T-200. There was 1 case of uterine perforation with a Copper-T-200, 1 case of pregnancy with a Nova-T and 2 ectopic pregnancies with Tcu-200. Bleeding and pain were the main reasons for IUD termination, with a comparable rate. The rate of expulsion for both devices is almost 50% of the termination rate for bleeding or pain. No pelvic infection has necessitated surgery. The rate of termination for infection is substantially higher in women under 25 and appears to depend on the age of the subject rather than on parity. Nova-T is designed in such a fashion that it keeps its shape better than Copper-T-200. This helps avoid the shifting of the device and might explain the lower pregnancy rate. It is equipped with a flexible loop at the end of the vertical arm, designed to avoid perforations of the uterus, which is 1 of the disadvantages of Copper-T-200. However no perforation was recorded in the study with either device, and consequently the efficiency of this loop has yet to be proved. Nova-T's copper thread has a silver core which prevents fragmentation.

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Prise en charge d'une infection pelvienne a Chlamydia trachomatis.

  • L’infection par Chlamydia trachomatis est une affection grave, qui affecte le tractus génital masculin et féminin, et qui induit des complications graves, chroniques et insidieuses du type infertilité et grossesse extrautérine. Le traitement antibiotique requis doit obligatoirement atteindre le milieu intracellulaire afin d’être suffisamment efficace pour éradiquer l’infection.

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Imagerie de l'infection pelvienne.

  • Les différents stades évolutifs de la pathologie inflammatoire du pelvis (endométrite, salpingite, pyosalpinx, abcès tubo-ovarien) sont détaillés. L'intérêt et la pertinence des différentes techniques d'imagerie (échographie endovaginale, tomodensitométrie, IRM et hystérosalpingographie) et les éléments séméiologiques fondamentaux orientant vers cette pathologie au stade aigu et au stade chronique sont rappelés.

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L'infection pelvienne: attitude diagnostique et thérapeutique.

  • Il faut un diagnostic précoce et aussi précis que possible. Un traitement antibiotique approprié. Un bon suivi avec des visites de contrôle fréquentes et le traitement de tous ces partenaires sexuels.

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