Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the cervix (cervicitis), uterus (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis), which can extend to the connective tissue lying between the broad ligaments (parametritis).

Early diagnosis and treatment prevents damage to the reproductive system. Untreated PID may cause infertility and may lead to potentially fatal septicemia, pulmonary emboli, and shock.

Causes

In some women, PID may result from a termination of pregnancy or following childbirth. Occasionally, it may be as a result of having sex with a new partner. But often no specific reason can be found. In the UK the 'bug' most commonly responsible for PID is Chlamydia.

Signs and symptoms

The following are the most common symptoms of PID. However, each individual may experience symptoms differently. Symptoms of PID include:

• diffuse pain and tenderness in the lower abdomen
• pelvic pain
• increased foul-smelling vaginal discharge
• fever and chills
• vomiting and nausea
• pain during sexual intercourse

Symptoms may be mild enough that the condition may go undiagnosed.

The symptoms of pelvic inflammatory disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Diagnosis

Diagnostic tests generally include:

• Gram stain of secretions from the endocervix or cul-de-sac, Culture and sensitivity testing aids selection of the appropriate antibiotic. Urethral and rectal secretions may also be cultured.
• ultrasonography to identify an adnexal or uterine mass. (X-rays seldom identify pelvic masses.)
• culdocentesis to obtain peritoneal fluid or pus for culture and sensitivity testing.

In addition, patient history is significant. In general, PID is associated with recent sexual intercourse, IUD insertion, childbirth, or abortion.

Treatment

To prevent progression of PID, antibiotic therapy begins immediately after culture specimens are obtained. Such therapy can be reevaluated as soon as laboratory test results are available (usually after 24 to 48 hours). Infection may become chronic if treated inadequately.

The guidelines of the Centers for Disease Control and Prevention (CDC) for outpatient treatment include a single dose of cefoxitin plus probenecid given concurrently or a single dose of ceftriaxone. Each of these regimens is given with doxycycline for 14 days.

The CDC guidelines for inpatient treatment include doxycycline alone or a combination of clindamycin and gentamicin.

Development of a pelvic abscess necessitates adequate drainage. A ruptured abscess is life-threatening. If this complication develops, the patient may need a total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Prevention

Preventive measure include following safer sex behaviors; following the health care provider's recommendations after gynecological events or procedures; and getting prompt treatment for sexually transmitted diseases. Sexual partners should also get adequate treatment.

The risk of PID can be reduced by getting regular STD screening exams, and by couples being tested before initiating sexual relations. Testing can detect STDs that may not be producing symptoms yet.