Pelvic Inflammatory Diseases

PELVIC INFLAMMATORY
DISEASES
• Pelvic Inflammatory disease is an infection of the
female’s reproductive organ.
• Usually caused by sexually transmitted bacteria
from the vagina towards the uterus, fallopian
tubes or ovaries, however, 15% of these
infections are not sexually transmitted.
• Several different types of bacteria can cause PID,
including the same bacteria that cause
the sexually transmitted infections
(STIs) gonorrhea and chlamydia.
• Reproductive organs affected by PID include the
uterus, ovaries and fallopian tubes.
Acute/chronic inflammation of upper genital
tract:
• Endometrium: Endometritis
• Fallopian Tubes : Salpingitis
• Ovaries : Oophoritis, TO abscess
Adjoining structures:
• Parametritis
• Pelvic peritonitis
• Pelvic abscess
EPIDEMIOLOGY
1-2 % IN YOUNG SEXUALLY ACTIVE WOMEN
85% 15%
Spontaneous
Iatrogenic
infection
RISK FACTORS
• Having intercourse under the age of 25
• Having intercourse with multiple partners
• Having unprotected intercourse
• Recently having an intrauterine device
inserted
• Douching
• Having a history of PID
CAUSES OF PID
• PID is caused by two sexually transmitted infections:
chlamydia or gonorrhea
• Bacterial vaginosis
• It is very unlikely that bacteria can enter your reproductive
tract until the normal barrier created by the cervix is
disturbed. This can happen during:
• menstruation
• after childbirth,
• miscarriage or abortion.
• during the insertion of an intrauterine device (IUD) — a
form of long-term birth control (very rare)
• any medical procedure that involves inserting instruments
into the uterus (very rare)
SIGNS & SYMPTOMS
• Pain or tenderness in the stomach or
lower abdomen (belly), the most common
symptom
• Abnormal vaginal discharge, usually yellow or
green with an unusual odor
• Chills or fever
• Nausea and vomiting
• Pain during interocurse
• Burning sensation during urination
• Irregular menstruation
• Pain in the right upper abdomen, less often
• Unusual bleeding from the vagina, especially
during or after intercourse, or between
menstruation
• Painful, frequent or difficult urination
• In cervicitis, the cervix appears red and bleeds
easily. Mucopurulent discharge is common;
usually, it is yellow-green and can be seen exuding
from the endocervical canal.
• Acute salpingitis: Lower abdominal pain is usually
present and bilateral but may be unilateral, even
when both tubes are involved. Pain can also occur
in the upper abdomen. Nausea and vomiting are
common when pain is severe. Irregular bleeding
(caused by endometritis) and fever each occur in
up to one third of patients.
• PID due to N. gonorrhoeae is usually more
acute and causes more severe symptoms than
that due to C. trachomatis, which can be
indolent.
• PID due to M. genitalium, like that due to C.
trachomatis, is also mild and should be
considered in women who do not respond to
first-line therapy for PID.
DIAGNOSIS
• Medical history, including asking about
general health, sexual activity and symptoms.
• Pelvic exam to examine the reproductive
organs and look for signs of infection
• Vaginal culture to take a sample of any
bacteria
• Blood tests to enquire about any infection
present
• Urine test to rule out a urinary test infection,
which causes similar pelvic pain
PID can cause scarring on the fallopian tubes

and permanent damage to the reproductive
organs. Hence , some additional tests may be
performed
• Ultrasound to get clearer images of the
reproductive system
• Endometrial Biopsy: to remove and test a
small tissue sample from the endometrium,
the lining of the uterus
• Laproscopy: a surgery using small incisions
and a lighted instrument to look closely at
reproductive organs
• Culdocentesis : with a needle inserted behind
the vagina to remove fluid for examination.
This procedure is much more rare then it used
to be, but is sometimes helpful
Clinical Diagnostic Criteria
• A sexually active woman
• Other woman at risk factor of PID
• C/o lower abdomen or pelvic pain
Additional Criteria
At least one:
• Temperature elevated
• Cervical/vaginal mucopurulent discharge
• Abundant WBC on saline M/E of vaginal fluid
• Elevated ESR
• Elevated CRP
• Lab documentation of infection with
N.Gonorrhoeae or C.Trachomatis
COMPLICATIONS
Untreated pelvic inflammatory disease might

cause scar tissue and pockets of infected fluid
(abscesses) to develop in the reproductive
tract. These can cause permanent damage to
the reproductive organs.
• Ectopic pregnancy: An ectopic pregnancy can
occur when untreated PID has caused scar
tissue to develop in the fallopian tubes. The
scar tissue prevents the fertilized egg from
making its way through the fallopian tube to
implant in the uterus. Instead, the egg
implants in the fallopian tube. Ectopic
pregnancies can cause massive, life-
threatening bleeding and require emergency
medical attention.
• Infertility: Damage to reproductive organs
may cause infertility — the inability to become
pregnant. The more the frequency of PID, the
greater the risk of infertility. Delaying
treatment for PID also dramatically increases
your risk of infertility.
• Chronic pelvic pain. Pelvic inflammatory
disease can cause pelvic pain that might last
for months or years. Scarring in your fallopian
tubes and other pelvic organs can cause pain
during intercourse and ovulation.
• Tubo-ovarian abscess: PID might cause an
abscess — a collection of pus — to form in the
reproductive tract. Most commonly,
abscesses affect the fallopian tubes and
ovaries, but they can also develop in the
uterus or in other pelvic organs. If an abscess
is left untreated, it could lead to a life-
threatening infection.
TREATMENT
• Antibiotics to treat infection
• The Centers for Disease Control and Prevention (CDC)
recommends oral doxycycline 100 mg twice daily for
14 days, along with a second- or third-generation
cephalosporin administered parenterally, for mild PID
in ambulatory patients
• Symptoms will start fading within 3 or 4 days but
medication must be continued for a longer period of
time (usually the course is of 14 days).
• Partner should also be treated
• Temporary abstinence: avoid intercourse until
treatment is completed and symptoms are resolved
• Guidelines of the Centers for Disease Control
and Prevention recommend outpatient
treatment of PID with ofloxacin, levofloxacin,
ceftriaxone plus doxycycline, or cefoxitin and
probenecid plus doxycycline, all with optional
metronidazole for full coverage against
anaerobes and bacterial vaginosis
Hospital admission is required for the following
reasons:
• If symptoms don’t improve even after taking
the medicines
• Severe infection
• Pregnancy
• Presence of abscess in the fallopian tube or
ovary
Surgical Treatment
• Although most patients with pelvic
inflammatory disease will respond to
conservative treatment, surgical intervention
occasionally is necessary.
• If an abscess ruptures or threatens to rupture,
it might need to get drained.
PREVENTION
• Practice safe intercourse: Use protective
techniques every time you have intercourse,
limit your number of partners
• Use protection even if you are following birth
control measures
• Get tested as soon as you experience
symptoms of STI
• Avoid douching
DIFFERENTIAL DIAGNOSIS
• Appendicitis
• Disturbed ectopic pregnancy
• Twisted/ruptured ovarian cyst
• Endometriosis
• Diverticulitis
• UTI
• Functional pain

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PELVIC INFLAMMATORY

1-2 % IN YOUNG SEXUALLY ACTIVE WOMEN

PID can cause scarring on the fallopian tubes

Untreated pelvic inflammatory disease might

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