A Simple Guide to Pelvic Inflammatory Disease

A Simple Guide to Pelvic Inflammatory Disease
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What is Pelvic Inflammatory Disease?
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Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.
These include endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis.

What is the cause of PID?
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It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea.

The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.

Sexually active women in their childbearing years are most likely to get PID.
Women under age 25 are more likely to develop PID than those older than 25.
The cervix of young women is not fully matured, and therefore more prone to be infected by STD.

Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.

Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.

What are the signs and symptoms of PID?
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Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.

Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).

How is PID diagnosed?
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Because the symptoms are often subtle and mild, most cases of PID go undetected.

Diagnosis is usually based on clinical findings:
1.lower abdominal pain

2.abnormal cervical or vaginal mucopurulent discharge

3.oral temperature >101°F (>38.3°C)
together with investigation findings
4.laboratory evidence of gonorrheal or chlamydial infection.

5.A wet specimen of vaginal fluid is able to detect the presence of concomitant infections ( bacterial vaginosis and trichomoniasis)

6. pelvic ultrasound is a helpful procedure for diagnosing PID.It can check the pelvic area to see whether there is an abscess or enlarged fallopian tubes.

7.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end in inserted through a cut in the navel area to view the internal pelvic organs and to take specimens for testing.
Other criteria for diagnosing PID include the following:
8.endometrial biopsy with histopathologic evidence of endometritis;

9.transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex,

10.doppler studies suggesting pelvic infection

What are the complications of PID?
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Prompt and appropriate treatment can help prevent complications of PID.

Without treatment, PID can cause

1. permanent damage to the female reproductive organs.
Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.

2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.

3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow.
As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting in abdominal pain, internal bleeding, and death.

4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.

5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.

6. abscess formation in the reproductive organs or pelvis which can spread to the blood and cause septicemia.

What is the treatment for PID?
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Treatment of PID should be initiated in
1.sexually active young women

2. pelvic or lower abdominal pain,

3. physical examination shows cervical motion tenderness, uterine tenderness or adnexal tenderness.

PID can be treated with several types of antibiotics(eg.clindamycin or metronidazole with doxycycline).
However, antibiotic treatment will not reverse any damage to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is important that she seek care immediately.
Prompt antibiotic treatment can prevent severe damage to reproductive organs.

PID is usually treated with at least two antibiotics given by mouth or by injection.
Even if symptoms go away, the woman should finish taking all of the prescribed medicine.
This will help prevent the infection from returning.

Hospitalization to treat PID may be recommended if the woman
(1) is severely ill with nausea, vomiting, and high fever

(2) is pregnant;

(3) does not respond to or cannot take oral medication and needs intravenous antibiotics;

(4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess).

(5)surgical emergencies (e.g., appendicitis) cannot be excluded;

If symptoms continue or if an abscess does not go away, surgery may be needed.

Complications of PID such as chronic pelvic pain and scarring improve with surgery.

How can PID be prevented?
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1. transmission of STDs can be prevented by abstainance from sexual intercourse,

2. a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected can prevent STD.

3.Latex male condoms, when used consistently and correctly, can reduce the transmission of chlamydia and gonorrhea.

4.chlamydia testing of all sexually active women age 25 or younger and of older women with risk factors for chlamydial infections especially those with a new sex partner or multiple sex partners

5.Any genital symptoms such as an unusual sore, discharge with odor, burning during urination, or bleeding between menstrual cycles suggests a STD infection. Early treatment of STDs can prevent PID.

6. Intrauterine contraceptive devices containing levonorgestrel-and copper-containing devices may cause PID and should be removed if antibiotics does not cure the PID.