Published - Tue, 02 Aug 2022

TREATMENT OF PELVIC PAIN

TREATMENT OF PELVIC PAIN

1. Vaginitis: 

a) Infectious vaginitis:

  • i) Fungal vaginitis
  • C. albicans vaginitis is treated with miconazole suppositories (200mg each evening for 3 to 7 days), oral fluconazole (150 mg orally once), or terconazole suppositories (80 mg each evening for 3 days).
  • Other fungal agents of vaginitis (e.g., Torulopsis glabrata) may be resistant to conventional antifungal treatment and may need longer therapy, repeated dosing, or systemic antifungal treatment.
  • ii) Trichomoniasis is treated with oral metronidazole (2 g administered in a single dose). In pregnant patients, a 7-day course of metronidazole (500 mg twice daily) or clotrimazole suppositories (inserted each evening for 7 days) can be used.
  • iii) Bacterial vaginitis is treated similarly to trichomoniasis. Metronidazole (500 mg twice daily for 7 days). Treatment with clotrimazole suppositories can be considered for pregnant patients with severe infections.

b) Foreign object vaginitis: Object removal and proper hygiene education.

c) Contact vaginitis is treated by terminating exposure to the offending agent.

d) Atrophic vaginitis is improved by applying topical estrogen cream daily for 5 to 10 days.


2. Cervicitis: Gonococcal and chlamydial infections are the focus of treatment for bacterial infection due to high frequencies of coinfection.

a) Gonococcal: Ceftriaxone (250 mg in one intramuscular dose) plus doxycycline (100 mg orally every 12 hours for 7 days). Doxycycline and tetracyclines should be avoided in pregnant women.

b) Chlamydial: Azithromycin (1 g administered in a single oral dose) or a 7-day course of doxycycline.

c) Viral: Herpes virus develops a latent state inside neuronal cells and cannot be removed from the body. To reduce the severity of the initial and reactivation symptoms, doctors may prescribe acyclovir (200 mg orally five times daily, or 400 mg orally three times daily for 10 days) or valacyclovir (1 g orally twice daily for 10 days).


3. PID: 

a) Outpatient therapy: Ceftriaxone (250 mg administered in a single, intramuscular injection) plus doxycycline and metronidazole for 14 days. 

b) Inpatient therapy: Appropriate regimens include:

  • —A cephalosporin (e.g., ceftriaxone, 1 g every 24 hours; cefotetan, 2g every 12 hours; or cefoxitin, 2 g every 6 hours) plus doxycycline (by mouth or IV).
  • —Clindamycin (900 mg every 8 hours) plus gentamicin (an initial loading dose of 2 mg/kg followed by a maintenance infusion of 1.5 mg/kg every 8 hours intravenously).
  • —Ampicillin/sulbactam (3 g IV four times daily) plus doxycycline.


4. Ectopic pregnancy:

a) General therapy: To avoid the possibility of maternal Rh antibody development, Rho(D) immune globulin is administered as a single intramuscular injection to all Rh-negative mothers. Possibly within 72 hours following the first incident of bleeding.

b) Specific therapy

  • i) Unruptured ectopic pregnancy: These patients are hemodynamically stable. Treatment options include:
  • Laparoscopic salpingostomy and ectopic excision.
  • Nonsurgical treatment with methotrexate, leucovorin, or mifepristone.
  • Salpingocentesis (i.e., transvaginal needle aspiration of the gestational sac, potentially with direct injection of methotrexate)
  • ii) Ectopic pregnancy without cardiac activity: The obstetrician may choose to treat patients without surgery if their β-hCG levels have been serially declining and repeat sonography has revealed no signs of erosion or rupture. It is possible to induce evacuation using medication. If there is any indication of erosion or rupture, laparoscopic intervention is carried out.

c) Ruptured ectopic pregnancy: These patients may be hemodynamically unstable, necessitating prompt fluid and blood resuscitation as well as bruising control. Salpingectomy with laparoscopic ectopic excision is advised.


5. Ovarian cyst: If sonographic evidence of free fluid in the cul-de-sac is seen without the need for treatment, a patient with a confirmed cyst may be sent home with pain medication. Surgery should be performed on patients who show signs of bleeding that may be active or have hemodynamic instability.


6. Ovarian torsion: Patients should have a laparoscopy or laparotomy for exploration and attempted salvage if their history, physical exam, and sonographic results are suspicious.


7. Endometriosis: To stop ectopic endometrial growth, oral contraceptive methods, methyltestosterone, or progesterone may be utilized. In refractory cases, surgery is used to remove the tumor.


8. Dysmenorrhea: It is possible to try oral contraceptive medication to slow endometrial development. Nonsteroidal anti-inflammatory medicines, such as ibuprofen or naproxen, are used to try to control pain. Drugs like opiates are usually avoided.



DISPOSITION

—Hemodynamically unstable patients are treated with aggressive fluid resuscitation (with blood products) and taken to the operating room.

—Hemodynamically stable patients are admitted for observation and treatment when an evolving surgical disease is suspected or the patient is at risk for systemic toxicity.

All patients who are discharged must-have follow-up arranged and verified before leaving the ED.

Created by

Rigomo Team

Rigomo is a leading online education platform that offers a wide range of courses to help individuals enhance their skills and achieve their career goals. With our user-friendly interface and expert instructors, we strive to provide high-quality education to everyone, anytime and anywhere. Join us today and take the first step towards a brighter future.

Rigomo is an e-learning platform that was founded in 2019 by a team of dedicated professionals with a passion for revolutionizing the way people learn. The platform offers a range of online courses that cover various industries, including business, technology, healthcare, and more.

Rigomo's courses are designed to be interactive and engaging, with a focus on practical skills that learners can apply in their careers. The platform uses a combination of video lectures, quizzes, and hands-on projects to help learners master the subject matter.

Rigomo is committed to providing affordable and accessible education to people around the world. The platform offers a range of pricing options, including monthly and annual subscriptions, as well as pay-as-you-go options for individual courses.

Since its launch, Rigomo has received numerous accolades for its innovative approach to e-learning. The platform has helped thousands of learners across the globe acquire new skills and advance their careers.

As Rigomo continues to grow, the team remains committed to providing high-quality education that is accessible to all. The platform is constantly updating its courses and features to ensure that learners have access to the latest tools and technologies.

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