Inflammation of the Female

Reproductive Tract
Self-cleansing
(lactobacillus)
Mucus
1. Vulvitis ( 外阴炎 )
Bartholinitis/Bartholin’s cyst
( 前庭大腺炎／前庭大腺囊肿 )
2. Vaginitis ( 阴道炎 )
3. Cervicitis ( 宫颈管炎 )
4. Pelvic inflammatory disease (PID) ( 盆腔炎 )
 Genital tuberculosis ( 生殖器结核 )
 Sexually transmitted diseases (STD) ( 性传
播疾病 )
Inflammed, Congestion
Vulvitis ( 外阴炎 )
Clinical Manifestation
Vulvar pruritus ( 瘙痒 )
Pain
Burning sensation
Congestion ( 充血 )
Swelling 肿胀
Eczema ( 湿疹 )
Profuse frothy greenish
 Etiology
Specific organisms or non-infective dermatitis ( 皮炎 )

• Irritation from vaginal discharge ( 分泌物 ) or menses

• Lack of vulvar hygiene
• Glycouria
 Treatment
• Keep the vulva clean and dry
• Remove the cause
• 1/5000 KMnSO4 (potassium permanganate,
PP)
solution bath
• Antibiotics ointment
Bartholinitis ( 前庭大腺炎 )
Infection of the major vestibular
glands ( 前庭大腺 )
(Bartholin’s glands) ( 巴氏腺 )

Bartholin’s Cyst ( 前庭大腺囊肿

)
Major vestibular glands (Bartholin’s glands)
Bartholinitis （前庭大腺炎）
Etiology
Staphylococcus, E.coli, streptococcus, enterococcus,
gonococcus, and polymicrobial infection is common.

Clinical manifestation
Symptoms of a local infection
Abscess of Bartholin gland: a painful red swelling

Treatment
Antibiotics (Ampicillin) in the early stage
Drain the abscess (excision of an elliptical piece of skin)
 Bartholin’s Cyst
( 前庭大腺囊肿 )

• Marsupialization ( 造口术 )
for preservation of the
gland function
• Excision for recurrent
cases
 Vaginitis
• Trichomonal vaginitis ( 滴虫性阴道炎 )
• Candidal Vulvovaginitis ( 假丝酵母菌性外阴阴道炎
)
• Bacterial Vaginosis (BV) ( 细菌性阴道病 )
• Senile vaginitis ( 老年性阴道炎 )
• Infantile vulvovaginitis ( 婴幼儿外阴阴道炎 )
Trichomonal Vaginitis
滴虫性阴道炎
(Trichomoniasis)
 Etiology
Trichomonad ( 毛滴虫 ) ：
A flagellate protozoan ( 有鞭毛原虫 )
Best living environment : Moist, anaerobic 厌
氧的 ,
pH value: 5.2-6.6, 25℃-42 ℃
 滴虫性阴道 炎
(trichomonal vaginitis)

• 一种由 阴道毛 滴虫
引起的 常见的 阴道
炎。
 临床表现

Typical symtom
典型
症状

稀薄 的泡沫 状白 带增多
persistent discharge+
外阴 瘙痒 pruritus vulvae
 正常图像 滴
虫图像
 Transmission 传播
1. Sexual contact (70% male infection,
asymptomatic 无症状的 carrier)
2. Nonsexual transmission (iatrogenic 医源性的 )

Pathogenesis
• The trichomonad lives on glycogen and iron of
the host cell
• Direct contact and damage of the target cell
• Induction of immune reaction resulting in
inflammation
 Clinical Picture
Latent period 潜伏期 : 4-28 days
Asymptomatic: 25-50%
Symptoms ：
Main: Profuse 大量的 vaginal discharge and pruritus
Occasional: odor, pain, dyspareunia , dysuria 排尿困难
infertility （ sperm ）
 Characteristics of the vaginal discharge
Copious ( 大量的 ) ,
Purulent ( 脓性的 ),
Gray to yellow color,
Malodorous ( 恶臭的 ),
Frothy ( 起泡沫的 )
Strawberry cervix:
Tiny, punctate hemorrhages
( 点状出血 )
grossly visible on the mucosa
 滴虫的“草莓状宫颈 strawberry
cervix”

Tiny, punctate hemorrhages

( 点状出 血 )
 Diagnosis
1. Microscopic (wet mount 湿涂 片 ) identification of the
trichomonad (sensitivity: 60%-70%)
2. Precautions for the examination
Avoid : intercourse 1-2 days before examination
washing and medication
lubricant 润滑剂
heat preservation
3. Culture for suspected 可疑 cases
4. PCR (Polymerase chain reaction)
 Treatment (1)
1. Systemic therapy (First choice,90-95% effective)
Oral metronidazole ( 甲硝唑，灭滴灵）
a) 2g single dose
b) 400mg, twice or 3 times a day, for 7 days.
2. Topical application 局部 应用 (≤50%effective)
a) Effervescent tablets ( 泡腾片 )of metronidazole
200mg/day, 7-10 days
b) Metronidazole gel
c) Acidification 酸化 of vagina with 1% lactic acid
or
0.5% acetic acid 醋酸
 Treatment (2)
Criterion for cure:
Negative finding in postmenstrual examination
of the vaginal discharge for three times
Failure rate: 5%-10%
Poor compliance 顺从性
Repeated infection
To avoid repeated infection:
Sterilization 杀菌 of underwear, towels 毛巾 , etc

Treatment of the sexual partner

Metronidazole is still effective in recurrent cases.
 Candidal Vulvovaginitis
假丝酵母菌性外阴阴道炎
(Vulvovaginal Candidiasis)
 Etiology
1. Very common
a) About 1/3 of vaginitis cases are caused by
fungal 霉菌 infection.
b) About 75% of women develop candidiasis at
least once in life.
2. The etiologic agent is Candida ( 假丝酵母菌 / 念珠
菌 ).
Candida albicans ( 白假丝酵母菌 ) is responsible
for 80-90% of vulvovaginal candidiasis.
3. Candida albicans is an opportunistic pathogen 条件致病菌
1) Suitable environment: acidic ( ＜ 4.5), warm, and moist
2) Candida albicans can be isolated from 10-20%
nonpregnant and 30% pregnant asymptomatic women.

Treatment
is not
indicated
unless
symptoms
are
present.
 Predisposing factors 易感 因素
1. Pregnancy
2. Diabetes mellitus
3. Immunosuppressants 免疫抑制剂
4. Broad-spectrum antibiotics
suppressing the vaginal normal flora 菌丛
(esp. lactobacillus)
5. Others: restrictive synthetic underwear,
obesity, contraceptive medication
 Transmission
1) Endogenous infection (most often)
vagina, oral cavity, intestinal tract
2) Sexual contact
3) Contacting fomites ( 污染物 )
 Pathogenesis
Two phases of candida albicans
1) Yeast 酵母 spores ( 芽孢相 ):
Asymptomatic parasitism
2) Pseudohyphae ( 菌丝相 ):
Pathogenic
3) Mechanism:
a) Candida at the pseudohypha phase penetrate
vaginal epithelium for nutrients
b) Growing candida albicans release proteolytic 蛋白水
enzymes and toxins etc. resulting in
inflammation reaction
 Clinical Picture
1. Vulvovaginal pruritus (main)
usually intense, coincident with menses or intercourse

2. Increased vaginal discharge

The classic finding is white, thick,curd-like 凝乳状的
discharge
forming patches 斑 adherent to the vaginal walls.
 Diagnosis
1. Wet mount microscopic identification of
candida albicans in the discharge
Saline: 30-50%
10% KOH: 70-80%
2. Gram’s stain 革兰氏染色 : 80%
3. Culture: higher sensitivity and drug test
4. Measurement of pH value may be useful for
discovering cases of complicated infection
(4.0-4.7).
a pH<4.5 simple infection
a pH>4.5 combined infection
 临床表现

典型症
状
• 白色稠厚豆渣样 白带增多
• +
• 外阴剧烈瘙痒
霉菌性阴道炎 TCT 图像
Yeast spores
Pseudohyphae
 Treatment
1. Elimination 除去 of predisposing factors
2. Topical application of antifungal agents 抗真菌剂
Vaginal suppositories ( 栓剂 ) ：
1) Miconazole ( 咪康唑 / 达克宁 )
a) 200mg/day for 7days
b) 400mg/day for 3 days
2) Clotrimazole ( 克霉唑 )
a) 150mg/day for 7 days
b) 150mg, twice a day for 3 days
c) 500mg single dose
3) Nystatin ( 制霉菌素 / 米可定 )
100,000units/day for 10-14 days
4) Methyl violet ( 龙胆紫 )
0.5-1% , 3-4 times/week for 2 weeks.
3. Systemic medication
Oral agents are used only for cases that can not be
treated with topical application of antifungal drugs.
8) Fluconazole ( 氟康唑 / 大扶康 )
150mg, single use.
2) Itraconazole ( 伊曲康唑 / 斯皮仁诺 )
a) 200mg/day for 3-5 days
b) 400mg for 1 day divided in two doses
3) Ketoconazole ( 酮康唑 )
200mg, once or twice/day until culture result is negative
Hepatotoxicity may occur.
Points of note for treating VVC
• Treatment should be followed-up with a premenstrual
examination of the vaginal discharge.
• Approximately 10% of cases will not respond to
initial therapy.
• Prolongation of treatment up to 14 days may cure
some patients.
• Identification and elimination of predisposing
factors is important.
• Recurrent VVC should be treated with oral therapy
followed by prophylactic doses.
 Treatment of sexual partner?
No treatment for asymptomatics.
15% should be treated
Bacterial Vaginosis
细菌性阴道病
 Etiology
1. Imbalance of normal vaginal flora
Diminution 减少 of Doderlein lactobacillus and
increase in other bacteria, in particular,
anaerobic bacteria.
2. Causative factors of the imbalance are unknown
Gardnerella vaginalis ( 加德纳菌 )
 Clinical Picture
Symptoms:
1. 10-40% asymptomatic
2. Mild pruritus or burning
sensation
3. Increased vaginal discharge
and fishy odor
Signs:
Discharge: thin, greyish-white,
homogenous, but not sticky
No inflammation reaction
(No epithelial edema 水肿 or erythema 红斑 )
 Diagnosis
Identification of clue cells *(wet mount in saline)
together with 3 of the following 4 items
1. Vaginal discharge: homogenous, thin and white
2. pH>4.5: in virtually all cases, usu. 5.0-5.5
3. Positive Whiff test (with 10% KOH)
4. Clue cells
* Clue cells are desquamated 脱屑的 epithelial cells
covered with clumps 丛，簇 of coccobacili 球杆
菌 esp. Gardnerella vaginalis ( 加德纳菌 ), which
gives the cells a speckled ( 有小斑点 ) appearance.
Whiff test
Ammonia odor
 诊 断
• 1. Vaginal discharge:
homogenous, thin and white
fishy odor

• 2. pH>4.5: in virtually all cases,

usu. 5.0-5.5

• 3. Positive Whiff test (with 10%

KOH) 胺臭 味试 验阳性

• 4. Clue cells 线索 细胞阳

性
 细菌 性阴 道病 线
索细胞
 Treatment (1)
1. Systemic therapy (oral) (80%)
1) Metronidazole
400mg, 2-3 times a day for 7 days
2) Clindamycin ( 克林霉素 / 氯林霉素 / 氯洁霉
素)
300mg, twice a day for 7 days
2. Topical therapy (80%)
1) Effervescent tablets of metronidazole
200mg/day, for 7-10 days
2) 2% Clindamycin cream, once a day for 7 days
3. Vaginal washing
1-3% H2O2 , 1% lactic acid, 0.5% acetic acid
 Treatment (2)
1. Systemic or topical treatment has the same cure rate (80%).
2. Patients who are asymptomatic, but scheduled to
have a gynecologic surgical procedure should be treated.
3. Patients who are pregnant can be treated with oral
metronidazole.
4. Follow-up examination should be given 1-2 and 3-4
weeks (postmenstrual) after the treatment.
Criteria for cure:
Absence of clue cells with at least 1 of the following items:
a) Normal vaginal discharge
b) pH≤4.5
c) Whiff test negative
Other forms of vulvovaginitis

1. Senile vaginitis ( 老年性阴道炎 )

Atrophic vaginitis( 萎缩性阴道炎 )
• Infantile vulvovaginitis
( 婴幼儿外阴阴道炎 )
 Differential Diagnosis of vaginitis
Bacterial Vaginosis Candidiasis Trichomoniasis

Complaints discharge↑m severe pruritus discharge↑

ild pruritus burning mild pruritus

Vaginal white white thin

discharge homogenous curd-like purulent
fishy frothy
normal edema punctate
Vaginal
erythema hemorrhage
epithelium
＞ 4.5 (4.7-5.7) ＜ 4.5 ＞ 5 (5.6-
＋ － 6.5)
Vaginal pH
Whiff test Clue cells Candida Trichomonad
WBC rare WBC some WBC many
Microscopic
 Inflammation of the Cervix
1. Common: 50% women of reproductive age
2. May lead to pelvic infection
3. Need to identify a venereal disease and
differentiate from malignancies

Cervicitis: Vaginal portion of the cervix (Ectocervix 宫颈阴道

Mucosa of the cervical canal (Endocervix 宫颈内
Acute Cervicitis
 Etiology
2. Neisseria gonorrhoeae ( 淋病奈瑟菌 )
Chlamydia trachomatis ( 沙眼衣原体 )
causing superficial infection of the cervical
columnar mucosa
2. Staphylococcus ( 葡萄球菌 )
Streptococcus ( 链球菌 )
Enterococcus ( 肠球菌 )
causing infection after an abortion, puerperium 产褥期 ,
cervical injury, foreign bodies
 Clinical Picture
Symptoms
1. Asymptomatic
2. Mucopurulent 粘液脓性的 vaginal discharge
Vaginal irritation symptoms:pruritus, burning sensation
Lumbosacral 腰骶部 pain,
Intermenstrual bleeding, postcoital bleeding
Symptoms of the lower urinary tract (urinary frequency 、
urgency 、 dysuria)
Signs
Inflammation of the cervix with mucopurulent
discharge (MPC for mucopurulent cervicitis)
 Appearance of discharge
• Gonorrheal infection: thick and creamy
• Trichomonal infection: foamy and
greenishwhite
• candidiasis infection: white and curd-like
• Bacterial vaginosis: thin and gray
• Chamydia infection: purulent discharge
from an angry ,reddened,congested cervix
 Diagnosis
1. Gram’s stain of the cervical discharge for leukocyte
≥30/HP or ≥10/×1,000
2. Tests for gonococcus 淋球菌 and chlamydia 衣原体
3. Wet mount microscopy for trichomonads 毛滴虫
Gonococcus under microscopy ： kidney-like
 Management
ystemic medication
hoice of drugs depends on the pathogens.
xamples:
Gonorrhea infection ： Third generation Cephalosporins
Ceftriaxone Sodium ( 头孢曲松钠 / 头孢三嗪 / 菌必治 / 罗氏芬
Spectinomycin ( 大观霉素 / 壮观霉素 / 淋必治 )
hlamydia trachomatis
Doxycycline ( 多西环素 )
Azithromycin ( 阿奇霉素 )
Erythromycin ( 红霉素 )
Ofloxacin ( 氧氟沙星 )
Chronic Cervicitis
 Clinical Features
1. Persistent leukohrrea usu. mucopurulent
2. Slight postcoital staining
3. Pains
lower abdominal discomfort, lumbosacral
backache, dysmenorrhea, dyspareunia
4. Infertility
5. Urinary symptoms
frequency, urgency, dysuria due to
subvesical lymphangitis not to cystitis
 Diagnosis
• The characteristic discharge from external os of the
cervix.
• Cytologic and colposcopic studies are helpful, but
only biopsy is definitive.
• Cultures are not so helpful.
 Treatment
Even if chronic endocervicitis is asymptomatic,
it should be treated.
1. Medical treatment
Systemic rather than topical
Based on culture and sensitivity test
2. Surgical treatment
A note of caution: postoperative bleeding （痂
crust ， scab 脱落 ablate ） , infection,
stricture 狭窄 formation, infertility.
Methods: thermal therapy 热疗 , cryotherapy 冷冻 ,
laser 激光 therapy
Pathological of chronic cervicitis
• 1.cervical erosion
• 2.cervical polp
• 3. endocervicitis
• 4. Naboth cyst
• 5.cervical hypertrophy
 Cervical Erosion
Etiology
3. When the stratified epithelium ( 复层上皮 ) which
normally covers the vaginal portion of the cervix
is replaced by columnar epithelium which is
continuous with that of the cervical canal.
2. Most erosion are not infected, nor they are the
result of inflammation.
3. Occurs in the newborns, pregnancy, oral
contraceptives
 Clinical Features
Symptoms
The only symptom is a mucoid 粘液的 discharge.
A slight postcoital bleeding (but malignancy should
be excluded)
Signs
A red area is seen around the external os.
Classification
Depends on the depth and area of the lesion
Types: simple 单纯型 , granular 颗粒型 , papillary
乳突型
Grades: I ( ＜ 1/3), II (1/3-2/3), III ( ＞ 2/3)
Grades: I ( ＜ 1/3), II (1/3-2/3), III ( ＞ 2/3)
 Treatment
• Erosion found on routine examination should
not be treated unless it is causing troublesome
discharge.
• A cervical smear is needed before the treatment,
and if necessary, colposcopy ( 阴道镜 ) and biopsy.
• Cervical ectropion ( 宫颈外翻 )
Physical therapy
Thermal cauterization,
Cryotherapy,
Laser therapy
 治疗
治疗前常规检查
细胞 学检 查
 Cervical Polyps
Small pedunculated( 有蒂的，有梗的 )
neoplasms of the cervix

• Endocervical polyp:
Originating from the endocervix
• Ectocervical polyp:
Originating from the vaginal portion
 Pathology
Gross appearance:
Endocervical polyp: Red or pink, rounded or tongue-like
Ectocervical polyp: Pale, flesh-colored, smooth, rounded
with a broad pedicle
Microscopic:
Vascular connective tissue stroma covered with columnar
or squamous epithelium or both. Congestion, edema or
leukocytein 白细胞 filtration may be present.
　　　　　
 Clinical Features
Some are asymptomatic.
Slight postcoital bleeding

Treatment
Cervical polyp should be treated.
• Malignant change (<1%)
• Polypoid cervical cancer

Twisting 扭动 off a polyp without an anesthetic

and cauterizing the base. Recurrent cases
are treated with canal dilation 扩张 and cauterization
of the stalk 蒂部 .
 Chronic Endocervicitis ( 宫颈粘膜炎 )
(Infection)

Etiology
Pathogens:
Normal cervical and vaginal flora
Pathology
• Thickened endocervix that produces a whitish pus
脓
• A cervical os surrounded by a reddish area
• Hypertrophy 肥大的 of the lacerated 撕裂的
cervix
 Clinical feature
• 1.persistent luekohrrea usu. Mucopurulent
• 2. slight postcoital staining
 Diagnosis
• the characteristic discharge from external
os of the cervix
• Cytologic and colposcopic studies are
helpful, but only biopsy is definitive
• Cultures are not so helpful.
 Treatment
• Even if chronic endocervitis is asymptomatic, it
should be treated.
• 1. medical treatment
• systemic rather than topical
• based on culture and sensitivity test
• 2 surgical treatment
• A note of caution: postoperative bleeding,
infection, stricture formation, infertility.
• Methods: thermal therapy, cryotherapy, laser
therapy, conization, hysterectomy.
 Nabothian cysts
• Retention 潴留 cysts of the cervical glands
caused by obstruction of the gland orifice
腺孔 by the growth of squamous
epitheliium. The cysts may be infected and
contain pus 脓 .
Cervical Hypertrophy
电刀： electrosurgical knife:electrocaulerization
 distinguish
• Submucous myoma
• Cervical cancer
This is the gross appearance of a cervical squamous cell
carcinoma that is still limited to the cervix (stage I).
Pelvic Inflammatory Disease (PID)
Infection of the upper genital tract
Terms:
Endometritis ( 子宫内膜炎 )
Salpingitis ( 输卵管炎 )
Oophoritis ( 卵巢炎 )
Myometritis ( 子宫肌炎 )
Pyosalpinx ( 输卵管积脓 )
Hydrosalpinx ( 输卵管积水 )
Peritonitis ( 腹膜炎 )
Tubal ovarian abscess (TOA) ( 输卵管卵巢脓肿 )
 Epidemiology
Sexual activity
A disease of sexually active, menstruating women.
Acute PID occurs in 1-2% of young sexually
active women annually.
Age
The peak incidence occurs in their late teens
and early twenties.
The most common serious infection in women
of 16-25 years of age
Contraceptive practices
Contraceptive methods No.of PID/woman-years
Sexually active, using no contraception: 3.42
Oral contraceptives: 0.91
Barrier methods 1.39
Intrauterine devices (IUD) 5.21
Financial cost
In USA, $3.5 billion 十亿 annually in 1990s

Medical sequelae 后遗症

Ectopic pregnancy: 6-10 fold increase
PID accounts for 50%
Chronic pain: 4 fold increase
Infertility: acute PID account for 5-60% of cases
Tubal obstruction: 11.4%, 23.1%,54.3% from 1, 2, 3
episodes of infection
Mortality 死亡率 : septic shock 脓毒血症性休克
and death
 Etiology
Pathogens that are sexually transmitted
1) Neisseria gonorrhoeae: in USA, 40-50% cases of PID
2) Chlamydia trachomatis: in USA, 10-40% cases of PID
The two pathogens may account for 2/3 of the PID
3) Mycoplasma ( 支原体 )
Recovered from the pus in 2-20% cases of salpingitis
Endogenous bacteria
1) Aerobic: streptococci, staphylococci, Escherichia coli
2) Anaerobic: Bacteroides fragilis ( 脆弱类杆菌 ),
peptococcus ( 消化球菌 ) ，
peptostreptococcus ( 消化链球菌 )
 Spreading Route of Infection
1. Ascending along the reproductive tract
For non-pregnant and non-puerperal women
Gonococcus, C. trachomatis, staphylococcus
2. Lymphatic vessels
In puerperal infection, post-abortion infection
and IUD associated infection
Streptococcus, E.coli, anaerobic bacteria
3. Blood vessels
Tuberculosis
4. Direct spreading
Infection from other visceral organs.
1 、经淋巴蔓延　
　 是产
褥感染，流
产后感染的
主要途经。
2 、经血循传播
为 TB
杆菌的主要
途径。
3 、沿生殖器粘膜上行蔓延
淋菌、衣
原体、葡萄
球菌。
4 、直接蔓
延
阑尾炎导
Acute PID
 Predisposing Factors
1. Intrauterine manipulation 操作
e.g. artificial abortion , IUD, etc.
2. Infection in the lower reproductive tract, esp. STD
3. Sexual activity
4. Bad hygiene
4. Direct spreading from adjacent viscera 内脏
6. Acute onset of a chronic PID
 Pathology
1. Acute endometritis and myometritis
2. Acute salpingitis, pyosalpinx 输卵管积脓 and
tubo-ovarian abscess 脓肿 (TOA)
3. Acute pelvic peritonitis 盆腔腹膜炎
4. Acute inflammation of the peritoneal
connective tissue (parametritis)( 宫旁结缔组织炎 )
5. Septicemia ( 败血症 ) and pyemia ( 脓毒血症 )
6. Fitz-Hugh-Curtis syndrome
 Fitz-Hugh-Curtis syndrome
Perihepatitis: 肝周炎 inflammation of Glisson’s capsule
without involvement of the liver parenchyma 肝实质 .
Suppurative ( 化脓性 ) and fibrous 纤维 exudation 渗出 of
capsule occurs causing adhesion between the capsule
and the anterior peritoneum.
• It happens in 5-10% cases of salpingitis. 输卵管炎
• It is caused by gonococcus 淋球菌 or Chlamydia trachomati
体.
• Edema and adhesion of the capsule may lead to pain
in the upper abdominal region.
Suppurative and fibrous exudation of the
capsule occurs causing adhesion between the capsule
and the anterior peritoneum.
 Clinical Features
Symptoms
Vary depending on severity and extent of the infection
and types of pathogens
Most common: lower abdominal pain, fever, increase
in vaginal discharge.
Gonorrhea/Chlamydia Trichomatis
Signs
Variable
Typical:
Bimanual examination:
 Diagnosis
Criteria for the diagnosis of PID
Minimum:
4) Pain on compression 压迫 of uterine body
or the adnexal 附件 region
2) Tenderness of the cervix
Specific:
1) Biopsy of the endometrium showing endometritis
2) Ultrasound/MRI identification of liquid-filled
enlarged oviducts or TOA
3) Laparoscopic examination
Additional:
 Differential Diagnosis

Appendicitis
Rupture or abortion of tubal pregnancy
Torsion or rupture of an ovarian tumor
 Treatment (1)
1. Systemic medication
(Ideal) Based on drug sensitivity test
(Empirical 经验的 ) Combination use of drugs
Patient’s condition and possible pathogens
1) Oral: Ofloxacin ( 氧氟沙星 ) Metronidazole for 14 days
2) Intravenous 静脉注射的 : Penicillin or Erythromycin ( 红霉
素)
Gentamycin ( 庆大霉素 ) or Amikacin ( 阿米卡星 / 丁胺卡那霉
素)
Metronidazole for endogenous bacteria
3) Cefuroxime sodium ( 头孢呋辛钠 / 西力欣 ) for gonococcus
4) Doxycycline ( 多西环素 / 强力霉素 ) or Azithromycin ( 阿奇霉
素)
 Treatment (2)
2. Surgical treatment
for TOA or peritoneal abscesses that can not be
controlled by drugs (2-3 days)
Indications:
1) Failure of drug therapy
2) Persistent existence of abscesses (2-3 weeks)
3) Rupture of the abscess
3. Traditional Chinese medicine
Chronic PID
 Etiology
1. Incomplete treatment of the acute PID
2. Infection from certain pathogens such
as Chlamydia trachomatis
3. Residual 残留的 lesions from previous acute PID

Characteristics of chronic PID:

1. Persistence of the condition
2. Difficult to identify the pathogens
 Pathology
1. Chronic endometritis
2. Chronic salpingitis and hydrosalpinx 输卵管积水
3. Salpingo-oophoritis 输卵管卵巢炎 and tubo-ovarian cyst
4. Chronic inflammation of pelvic connective tissue 结缔组织
 tubo-ovarian cys

hydrosalpin
x
hydrosalpinx
 Clinical Features
1. Chronic pelvic pain
2. Infertility (20-30%) and ectopic pregnancy
3. Abnormal menstrual cycle
4. Systemic symptoms
5. Signs
 Diagnosis
Based on history of acute PID, symptoms and signs

Differential diagnosis

Pelvic congestion or varicosity ( 静脉曲张 )

Endometriosis
Tumors

Ultrasound and laparoscopic examination is helpful

 Treatment
According to place of the lesion and
the patient’s complaint
Usu. comprehensive treatment is required.
1. Physical
2. Traditional Chinese medicine ( 赤丹丸 )
3. Antibiotics ( 抗炎 II 号栓 )
4. Drugs that dissolve 溶解 and absorb
inflammatory lesions
5. Surgical treatment