Pelvic inflammatory disease is an infection of a woman's reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID
4. definition
Pelvic inflammatory disease (PID) is infection of a
woman's reproductive organs. Infection spreads
upward from the cervix to the uterus, fallopian
tubes, ovaries, and surrounding structures
Its involve:
1- endometritis (inflammation of the uterus)
2- salpingitis (inflammation of fallopian tub)
3- salpingo - oophoritis (inflammation of fallopian tub
and ovaries)
4- tubo-ovarian abscess
5- pelvic peritonitis (Inflammation of the peritoneum
surrounding the uterus and the fallopian tubes)
7. Bacterial Causes:
1-Neisseria gonorrhoeae (Gonococcus):
bacterial of STDs
2- Chlamydia trachomatis
Both they cause infection (cervicitis). These
infections may remain in the cervix or spread
upward, causing pelvic inflammatory disease
Others:
3- clostridium perfineus
A septic technique ( illegal abortion)
4- actinomyces specied
IUD related infection
8. Causes by virus :
6- endogenous vaginal and perineal flora
* Gardnerella vaginalis
* Streptococcus agalactiae
* Peptostreptococcus species
* Bacteroides species (other than
Bacteroides fragilis)
* Genital Mycoplasma and Ureaplasma
species
1- herpes simplex virus
2-cytomegalovirus
9. Clinical presentation:
* bilateral lower abdominal pain.
* Vaginal discharge (Foul-smelling & large amount)
* Low back pain
* Irregular vaginal bleeding
* fever
* Painful sexual intercourse
Other symptoms depending on the severity of the
infection, patients with pelvic inflammatory disease
may be minimally symptomatic or may present with
toxic symptoms of fever, nausea, vomiting, and
severe pain.
Gonococcal pelvic inflammatory disease is thought to
have an abrupt onset with more toxic symptoms than
nongonococcal disease.
Gonorrhea- and chlamydia-associated infections are
more likely to cause symptoms toward the end of
menses and in the first 10 days following the
menstrual period.
10. investigations
1-Urinalysis to check for bladder and kidney
infection
2-A complete blood count (although fewer than
half of women with acute PID have a high white
blood cell count indicating an infection)
3-endocervical swab
4-aspirate pus
5-culture & sensitivity test
6- urine pregnancy test
7- ultra sound or CT scan (for abscess & ectopic
pregnancy)
11. Complications:
1-Recurrent PID
This can happen if an infection hasn’t been completely
cured or if the patient have been reinfected
2-Abscess (if ruptures it life threatening )
3-chronic pelvic pain
Scarring can cause pelvic tissues and organs to
stick together
* PID can cause scarring inside the reproductive organs
lead to:
4- infertility
5- ectopic pregnancy (the leading cause of pregnancy-
related deaths in adult females)
6- Fitz-Hugh-Curtis syndrome
inflammation of the liver capsule (capsule of
12. Prognosis
Although the PID infection itself may be cured,
effects of the infection may be permanent
If the initial infection is mostly in the lower tract,
after treatment the person may have few
difficulties. If the infection is in the fallopian tubes
or ovaries, more serious complications are more
likely to occur.
13. Differential diagnosis:
1- Appendicitis
2- ectopic pregnancy
3- septic abortion
4- hemorrhagic or ruptured ovarian cysts or
tumors,
5-twisted ovarian cyst
6-degeneration of a myoma, and acute enteritis
must be considered.
14. management
1- admitted into the hospital
if she pregnant ، she has Tubo-ovarian
abscesses failure of responding to oral therapy ،
immunodeficient patients
2-investigations to rule out life-threatening condition
3- Removal of IUCD
4-drainage abscess
Treatment :
1- medications
2-surgery
15. Medications:
Combination therapy:
ceftriaxone 250 mg im as one
dose
plus doxycycline 100 mg
orally 12 hourly for 14 days
plus metronidazole 400 mg
orally 12 hourly for 14 days
Tetracycline for Chlamydia
trachomatis
16. Surgery :
1- Salpingectomy
This is the removal of one or both of the fallopian
tubes. It will only stop PID if the infection is
confined to the tube(s), it is major abdominal
surgery and may cause additional pelvic
adhesions. If both tubes are removed, the
patients no longer can be able to get pregnant
naturally
2- Hysterectomy
A hysterectomy removes the uterus (womb) and
usually the cervix. A hysterectomy may reduce
pelvic pain. If the infection or scarring is outside
of the womb, for example, a hysterectomy will be
18. 3- Oophorectomy
This is the removal of one or both ovaries,
and is sometimes done at the same time as
a hysterectomy. If both ovaries are removed,
you will have a sudden, immediate
menopause.
4- abdominal surgery
for intra abdominal rupture of abscess
with peritonitis
19. Prevention:
1- Patient education
2- safe sexual practice by using barrier methods
such as condoms
3- early diagnosis and
proper treatment to partners to prevent reinfection
or spreading the infection to other people.
4- chemoprophylaxis (post abortion ، post
operative)
