This document discusses acute pelvic inflammatory disease (PID). It defines PID as an infection of the upper female genital tract that occurs from ascending infection from the lower tract. PID affects approximately 1 million women in the US annually and can cause hospitalization or even death. Risk factors include age, sexual activity, affected male partners, IUD use, and douching. Causative organisms are often sexually transmitted, including Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma species. Diagnosis can be difficult as symptoms are vague, and delay leads to more serious complications. Treatment involves broad-spectrum antibiotics, sometimes requiring hospitalization, while prevention focuses on partner treatment and

1. Acute Pelvic Inflammatory
Disease (PID)
Ahmed Walid Anwar Morad
Assistant professor of OBs& Gyn
Faculty of Medicine
Benha University

2. This talk spotlights on
• What is Pelvic Inflammatory Disease?
• What is the epidemiology of PID
• What are risk and protective factors
• What are the causes of PID
• Diagnosis
• Treatment
• Prevention

3. What is PID?
• PID is an infection of the upper female genital
tract.
• PID represents ascending infection from the
lower female genital tract.

4. • Occurs in approximately 1 million USA. women annually.
• Many hospital admissions.
• Sometimes fatal.
• Associated with short term and long term sequels.

5. Risk factors of PID
1. Age
2. Sexual activity
3. Affected male partner with STDs
4. IUCD
5. Vaginal douches
6. Previous history of PID

6. Protective factors of PID
1. Pregnancy
2. Combined oral contraceptives
3. Barrier contraception
4. Sterilization
5. Good immunity & high serum chylamidial
antibody titre
6. Age

7. Causes of PID
= Causative Organisms
& Mode of infections

8. Causative Organisms
• 85 – 95% specific sexually transmitted
organisms
• Neisseria gonorrhoea. 30-60%
• Chlamydia trachomatis. 15-20%
• Mycoplasma species. 5-10%
• Endogenous commensal organisms
• Anaerobes e.g. Bacteroides
• Aerobes e.g. E Coli, Streptococcus species
• Actinomycosis with IUCD
• A smaller number: Tuberculosis (TB)

9. Mode of infections
• Ascending
– Lumen
– lymphatic
• Blood born
• Direct spread

10. PID comes in two forms...
Acute PID Chronic PID
Organism Highly virulent Low virulent
Specific or
nonspecific
Symptoms Generalized No or mild
Duration Few days Months and years
Course Recur in episodes Progressive organ
damage & change
Fate Very infectious Acute
exacerbation or
arrested

11. Diagnosis of PID
• Vague symptoms /signs
• Often asymptomatic or mild
• No single finding is sensitive or specific
• Delayed diagnosis causes serious squeals.

18. Laparoscopic grading of PID

20. Clinical staging of acute PID

22. Fitz-Hugh-Curtis

23. Fitz-Hugh-Curtis Syndrome
• Perihepatic inflammation & adhesions
• Occurs with 1 – 10% acute PID
• Causes RUQ and pleuritic pain
• May be confused with cholecystitis or
pneumonia

28. Treatment of acute
PID

29. Principles of PID treatment
• Therapeutic goal:
• Elimination of acute infection
• Prevention of complications
• Start : Once diagnosis is suspected
• Antibiotics : Empiric broad spectrum
considering
• STDs ( N. gonorrhea& C. trachomatos)
• Anaerobes

30. Which regime
• Oral or parental
• Optimum duration
• Outpatient or inpatient regime.
• Indications of hospital admission
• Consider
• Coast
• Availability
• Disease severity
• Patient acceptance

35. Indications of surgical
management of PID
• Diagnosis : uncertain
• Disease : sever( tubo-ovarian abscess
and/ or pelvic abscess)
• Medical treatment : failed

42. • Same antibiotic regimens
as HIV negative women.
• Increased incidence of
mycoplasma hominis and
streptococcus infections.
• More incidence of TO
abscess.

43. Pregnancy
• Effects of PID
• Maternal : increased morbidity
• Fetal : preterm labor
• Neonate: Chlamydia
• Treatment
• Hospitalization
• IV antibiotics
• Avoid teratogenes ( tetracycline)
• Follow up: if Chlamydia infection:
confirm cure 3-4 wks, after 3 months then
3rd
trimester for high risk.

45. Postmenopausal women
Considerations:
• Rare disease.
• Commonly iatrogenic cause.
• Organisms:
– Common : anaerobes, Ecoli, Klebsiella
– Rare: STDs
• Tubo-ovarian abscess is common.
• Extragenital pathology should be considered.
Treatment
• Inpatient parental treatment
• Surgical exploration if no improvement within 48 hours.
• Aggressive treatment to reduce morbidity and mortality

47. Take home message
• Over diagnosis of PID is better than
waiting complications.
• Broad spectrum antibiotics.
• Inpatient or outpatient treatment when
appropriate.
• Surgery when indicated.
• Partner treatment
• Prevention ( 1ry, 2ndry & tertiary)

48. Thank You
Any Questions or
Comments?