Enfermedad

Pélvica
Inflamatoria
(EPI)
Mariana Duran- Marian Ochoa- Jose Álvarez- Juan Camilo Sánchez- Santiago Velandia.
 Tabla de contenido
01 02 03
Definiciones, Fisiopatología y Presentación
epidemiología y factores de riesgo clínica y
Etiología diagnóstico

04 05 06
Diagnósticos Tratamiento Estudio PEACH
diferenciales y
complicaciones
01 DEFINICIÓN
EPIDEMIOLOGÍA/ETIOLOGÍA
1.1 DEFINICIÓN

● Infección aguda y subclínica

polimicrobiana del tracto genital superior

● Espectro de alteraciones inflamatorias

del tracto genital superior

● Salpingitis
● Endometritis
● Absceso tubo-ovárico
● Peritonitis pélvica
 1.2 EPIDEMIOLOGÍA
● Efectos sobre la salud reproductiva de las mujeres
¿Por qué es importante? ● Prevalencia en mujeres con edad reproductiva
● Costos en salud ($1,995 )

CDC

● Prevalencia: 4.5% de las mujeres en edad reproductiva (18-44

años)
● Incidencia: 1 millón de mujeres por año

● Infertilidad (⅛ mujeres)
● Dolor pélvico crónico
1.3 ETIOLOGÍA

La microbiología de la EPI debe verse y tratarse como una infección polimicrobiana mixta
(facultativa y anaeróbica).

85% Casos EPI causados por patógenos de transmisión sexual o patógenos asociados con
la vaginosis bacteriana.

Premenopaúsicas Posmenopaúsicas

❖ Chlamydia trachomatis ● Anaerobios

❖ Neisseria gonorrhoeae ● E. Coli
➢ Mycoplasma genitalium
 1.3 ETIOLOGÍA
Chlamydia trachomatis Neisseria gonorrhoeae

1. Clamidia genital es la enfermedad 1. N. gonorrhoeae fue la primera causa

bacteriana de transmisión sexual más identificada de EPI
común. 2. Aprox. 15% desarrollan EPI
2. C. trachomatis representa alrededor de 3. Tiende a ser clínicamente más grave que la EPI
un tercio de los casos de EPI por clamidia,
02 FISIOPATOLOGÍA
FACTORES DE RIESGO
03 BARRERA FISIOLÓGICA

● Componente más importante

contra el ascenso bacteriano es la
barrera física del cuello uterino.
● Barrera mucosa
● Gonorrea o Clamidia endometrial.
● Fase proliferativa del ciclo
menstrual

Moco cervical
03 FISIOLOGÍA
 03 FISIOPATOLOGÍA
Alteración de
células ciliares.
Ascenso de
microorganismos al Translocación a
endometrio. trompas y anexos

Respuesta Formación de cicatrices y

Alteración de la inflamatoria del adherencias
microbiota tejido endometrial
 04 FACTORES DE RIESGO
Identificarlos mejora repercusión en tratamiento y prevención.

● N. gonorrhoeae y C. trachomatis.
● Múltiples parejas sexuales.
4 FACTORES
● Antecedentes de EPI.
● Edad ● Inmunosupresión.
● Riesgo de exposición ● Lesiones cervicales.
● Riesgo de progresión de la ● Vaginosis bacteriana
infección. ● Antecedente de ETS.
● La introducción de un DIU. ● Tabaquismo.
● Antecedente de ducha vaginal.
● Estado socioeconómico bajo.
● No uso de ACOH
 Presentación Clinica

Dolor abdominal
Disuria intenso

Sangrado
Fiebre intermenstrual

Flujo vaginal Dispareunia

 Diagnostico
Antecedentes
Examen pelvico
● Infecciones de transmision sexual
● Detectar sensibilicacion
● Metodo anticonceptivo
● Tacto vaginal

● Imagenes diagnosticas: Ecografia transvarginal

● Doppler que muestran un aumento del flujo
sanguíneo en las trompas de Falopio
● Uroanalisis
● Hemograma, PCR
● Cultivo vaginal
●
 Diagnósticos

04 Diferenciales y
Complicaciones
 Diagnósticos Diferenaciales
Apendicits Nefrolitiasis Emb. ectópico

Ruptura de Quiste
Torsión ovárica Gastroenteritis
Ovárico

Celulitis pélvica Endometriosis

 Complicaciones a largo plazo
Hidrosalpinx EPI recurrente Dolor pelvico crónico

Infertilidad Emb. ectópico Ca. ovario

05 TRATAMIENTO
AMBULATORIO- INTRAHOSPITALARIO
 Generalidades del Tratamiento

Diagnóstico de EPI Inicio de Esquema Antibiótico Tratamiento de la pareja

Criterios de Hospitalización Control a 72 hrs

 ¿CUÁNDO HOSPITALIZAR?

Criterios de manejo intrahospitalario

● No se ha descartado que se pueda tratar de una urgencia quirúrgica

● Embarazo
● Ausencia de respuesta clínica a las 72 hrs de iniciar manejo antibiótico oral
● Incapacidad para cumplir o tolerar el manejo ambulatorio.
● Malas condiciones generales, fiebre alta (38.5º) , Naúsea, vómito.
● EPI complicada con absceso Tuvo-ovárico
● Preocupación de mala adherencia al tratamiento.
¿CUÁNDO HOSPITALIZAR?
 Régimen antibiótico- Ambulatorio
Neisseria gonorrhoeae y Chlamydia trachomatis.

Ceftriaxona 250 mg IM dosis única Y Doxiciclina 100 mg IV/ VO cada 12 horas X 14 días

Cefoxitina 2 mg IM dosis única + Probenecida 1gr VO Y Doxiciclina 100 mg VO por 14

días

La recomendación actual de la
¿Cubrimiento anaerobio? CDC es considerar regímenes
¡Si no mejora a las 72 horas o antes, debenanaerobia
con cobertura ser
hospitalizados, recibir AB parenteral y realizar
¿Vaginosis bacteriana?
estudios para descartar absceso tuboovárico!
Metronidazol 500 mg IV cada 12H por
14 días
 Regímenes alternativos

Azitromicina VO o IV en monoterapia O combinada con doxiciclina y metronidazol

M. genitalium Moxifloxacina

Sospechar en caso de no respuesta

a manejo inicial
Esquema Antibiótico Intrahospitalario
Esquema Antibiótico Intrahospitalario

14 días

Transición a terapia oral según

criterio médico

24 - 48 horas luego de mejoría

Esquema Antibiótico Intrahospitalario

Transición a terapia oral según

criterio médico

24 - 48 horas luego de mejoría

Clindamicina 450mg VO c/6h x 14 días

Ó
Doxiciclina 100mg c/12 h x 14 días

Considerar Metronidazol 500mg c/12 horas x

14 días
 Consideraciones adicionales
● Parejas sexuales masculinas.
Parejas sexuales ● Últimos 60 días
● Pareja sexual más reciente si >60 días

Tratamiento empírico para Neisseria gonorrhoeae

y Chlamydia trachomatis.

Relaciones sexuales Pacientes deben abstenerse de relaciones

sexuales hasta finalización del tto, mejoría de
síntomas y tto de pareja.

Detección de ETS VIH, Hepatitis B, Sífilis

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Introduction
Mercury is the closest planet to
the Sun and the smallest one in
the Solar System—it’s only a bit
larger than the Moon
 About the Disease

01 02
Mars Jupiter
Despite being red, Mars It’s the biggest planet in
is actually a cold place the Solar System

03
Saturn
Yes, this is the ringed
one. It’s a gas giant
 Some Symptoms of the Disease

Mercury is the closest Despite being red, Mars

planet to the Sun is a cold place

Venus is the second Jupiter is the biggest

planet from the Sun planet of them all
How do I get PID?
You are more likely to get PID if you:

● Have an STD and do not get treated

● Have more than one sex partner
● Have a sex partner who has sex
partners other than you
● Have had PID before
● Are sexually active and are age 25 or
younger
● Douche
“This is a quote, words full of wisdom
that someone important said and can
make the reader get inspired.”

—Someone Famous
 About the Disease

Mercury is the closest Despite being red, Mars

planet to the Sun is a cold place

Venus is the second Jupiter is the biggest

planet from the Sun planet of them all
 About the Disease

10% 30% 25% 50%

Mercury Venus Mars Neptune
Mercury is the Venus has a Mars is actually a Neptune is the
smallest planet beautiful name cold place farthest planet
 How Can I Prevent PID?

Venus is the second Jupiter is the biggest

planet from the Sun planet of them all

Mercury is the closest Despite being red,

planet to the Sun Mars is a cold place
 02
Diagnosis
Enter a subtitle here if you need it
 How Is PID Diagnosed?
● You have an abscess in a fallopian tube or ovary
● You are pregnant
● Your symptoms do not go away after taking the antibiotics or if you cannot
swallow pills. If this is the case, you will need IV antibiotics
● You are very sick
 Diagnosis

Mercury Venus Mars

Mercury is the smallest Venus is the second planet Mars is a cold place

Jupiter Saturn Neptune

It’s the biggest planet Saturn has several rings Neptune is the farthest
 Concepts and Typology

Type B Type A Gestational

Jupiter is a gas giant and Despite being red, Mars Saturn is a gas giant and
the biggest planet in the is actually a cold place. has several rings. This
Solar System. It’s the It’s full of iron oxide dust, planet is composed
fourth-brightest object which gives the planet its mostly of hydrogen and
in the sky reddish cast also helium
 Hereditary Factors
Saturn Neptune
It’s composed of Neptune is the farthest
hydrogen and helium planet from the Sun

02 04

01 03

Mars Jupiter
Despite being red, Mars Jupiter is a gas giant and
is a cold place the biggest planet
 Research on PID

Earth Sun
We live on this planet The Sun is a star

Jupiter Neptune
Jupiter is a gas giant Neptune is far away
 Symptoms of the Disease

Saturn Neptune
This is the Neptune is the
ringed one. It’s a farthest planet
gas giant from the Sun

Mars Jupiter
Despite being Jupiter is a gas
red, Mars is a giant and the
cold place biggest planet
Organs Affected

Neptune
Neptune is the farthest planet from the Sun

Jupiter
Jupiter is a gas giant and the biggest planet

Mars
Despite being red, Mars is a cold place

Saturn
This is the ringed one. It’s a gas giant
 03
Recommendations
Enter a subtitle here if you need it
 Recommendations

What to Avoid What to Do

01. You can describe what the 01. You can describe what the
patient shouldn’t do here patient should do here

02. You can describe what the 02. You can describe what the
patient shouldn’t do here patient should do here
03. You can describe what the
03. You can describe what the
patient should do here
patient shouldn’t do here
A PICTURE IS
WORTH A
THOUSAND
WORDS
 Tips to Avoid PID

1. You can describe what the patient shouldn’t do here

What to Avoid 2. You can describe what the patient shouldn’t do here

3. You can describe what the patient shouldn’t do here

1. You can describe what the patient shouldn’t do here

What to Do 2. You can describe what the patient shouldn’t do here

3. You can describe what the patient shouldn’t do here

 04
Pathology
Enter a subtitle here if you need it
 Bacteria Stages

Saturn Mercury
Saturn is the ringed one. Mercury is the smallest
It’s composed of and innermost planet in
hydrogen and helium the Solar System

Jupiter Venus
Jupiter is a gas giant and Despite its beautiful
the biggest planet in the name, its atmosphere is
Solar System poisonous
 Pathology
Mercury is the closest planet to the Sun, but does its name have
anything to do with the liquid metal?

Saturn Jupiter Venus

Saturn is the ringed one. Jupiter is a gas giant and Despite its beautiful
It’s composed of the biggest planet in the name, its atmosphere is
hydrogen and helium Solar System poisonous
 PID Cases

Disease cases

Study period
2011-2017

Region
Spain

Special features
Absolute registration number

To modify this graph, click on it, follow the link, change the data and paste the resulting graph here
 Annual Number of Cases

Number of cases

Study period
2012-2019

Region
United Kingdom (England)

Supplementary note
Sources adds that diagnoses not exclusively
transmitted by sexual contact

To modify this graph, click on it, follow the link, change the data and paste the resulting graph here
 Percentages

Endometrial biopsy
20%
30%
Insertion of IUD
15%
Uterine Curettage

35% Hysterosalpingography

To modify this graph, click on it, follow the link, change the data and paste the resulting graph here
 Risk Factors

To modify this graph, click on it,

follow the link, change the data and 58%
58%
paste the resulting graph here
50% 52%
40%

Saturn 36%

Mars

Neptune

Jupiter
 Ways of Contagion

Saturn Jupiter
It’s composed of It’s the biggest planet
hydrogen and helium of them all

Venus Mercury
It’s the second planet It’s the smallest
from the Sun planet of them all
 Key Numbers

50,000
200,000 Saturn

Neptune
5,000
Mars
A PICTURE IS
WORTH A
THOUSAND
WORDS
 Gravity Distribution

60%
Subclinical PID
36%
Mild-Moderate
4%
Severe
 What Are the Signs and Symptoms?

Signs and symptoms include:

● Pain in the lower abdomen (this is the most
common symptom)
● Fever (100.4° F or higher)
● Vaginal discharge that may smell foul
● Painful sex
● Pain when urinating
● Irregular menstrual periods
● Pain in the upper right abdomen (this is rare)
 Prevention

Saturn

Jupiter Mars Venus

Jupiter is a gas giant and Despite being red, Mars Venus is the second
the biggest planet is actually a cold place planet from the Sun
 Results
Experiment A Experiment B

Treatment Test 1 Test 2 Test 3 Treatment Test 1 Test 2 Test 3

Group 1 254 458 213 Group 1 180 154 320

Group 2 454 552 128 Group 2 127 162 123

Group 3 454 457 445 Group 3 635 130 110

 Patient Profile

Variable (n= 101) Surgical need (n=35) p-value

Age 23 (20-38) 34 (22-40) 0.224

Civil Status (53/101) (52.5) 12 (37.1) 0.174

Start of relationships 17 (15-18) 15 (15-19) 0.478

NCS 2 (1-3) 1 (1-4) 0.728

Contraception (63/1019) (61.4) (15-35) 0.357

Ultrasound findings 33 (31.68) 5 (20) < 0.0001*

 Retrospective Analysis
Reasons for hospital admission of patients

Symptoms Degree of pain Percentages

Pain 8 14.2

Fever and pain 16 28.5

Fever + pain + leucorrhea 30 53.5

Pain + bleeding 2 3.5

Total 56 100
750,000
Total of cases in the world
66%
Less than 25 years

33%
30 years or older
Prevalence

Mercury
Mercury is the
smallest planet

Jupiter
Jupiter is the
biggest planet
 Sexually Transmitted Diseases

126M 96M

WHO Region of the Americas

128M
26M
WHO Western Pacific Region

WHO African Region 96M

WHO Eastern Mediterranean

WHO European Region

 References

● AUTHOR (YEAR). Title of the publication. Publisher

● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
 05
Treatment
Enter a subtitle here if you need it
 Treatment

30% 58%

Mars
Despite being red, Mars is
actually a cold place

Venus
Venus has a beautiful name,
but it’s very hot
 Intramuscular/Oral Treatment

Recommended Intramuscular/Oral Regimens

● Ceftriaxone: ● Doxycycline:
○ 250 mg IM in a single dose PLUS ○ 100 mg orally twice a day for 14 days

● Doxycycline: ● Metronidazole:

○ 100 mg orally twice a day for 14 days ○ 500 mg orally twice a day for 14 days

● Cefoxitin: ● Cephalosporin:
○ 500 mg orally twice a day for 14 days
○ 2g IM in a single dose and Probenecid, 1 g
orally administered
 Treatment Effectiveness

Pills
40% Despite being red, Mars is
actually a cold place

Injection
84% Venus has a beautiful name,
but it’s very hot
 Our Team

Dr. Jenna James Dr. James John Dr. John Smith

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 Invited Doctors

Dr. Lisa Smith Dr. Jennifer Lau

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 06
Conclusions
Enter a subtitle here if you need it
 Conclusions

Research Conclusions
Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s
only a bit larger than the Moon
 Conclusions

Research Conclusions
Mercury is the closest planet to the Sun and
the smallest one in the Solar System—it’s
only a bit larger than the Moon
 Advice

1. Venus has a beautiful name, but

also high temperatures 2. Jupiter is a gas giant and the
biggest planet of them all

3. Despite being red, Mars is

actually a very cold place 4. Saturn is the sixth planet from the
Sun and the second-largest
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