Pelvic inflammatory disease (PID) refers to ascending pelvic infections beyond the cervix that can involve the fallopian tubes, ovaries, peritoneum or pelvic vascular system. It is often caused by gonorrhea or chlamydia but can be caused by other bacteria as well. Risk factors include multiple sexual partners and unprotected sex. Symptoms include abdominal pain, fever, nausea and abnormal bleeding or discharge. Treatment involves antibiotics, bed rest, pain medication and sometimes surgery for severe or resistant cases. Complications can include infertility, chronic pain and ectopic pregnancy.

1. PELVIC INFLAMMATORY
DISEASE

2. DEFINITION
 This means all ascending pelvic infections once they
are beyond the cervix.
 Pelvic inflammatory disease may involve the fallopian
tubes, ovaries, peritoneum or pelvic vascular system.
 The disease may be acute or chronic.
 Symptoms may follow labour and delivery, a criminally
induced abortion (unsafe abortion), surgical
procedures or contact with gonorrhoea.

3. CAUSES
 Many organisms may be responsible however the most
frequent are gonococcus and staph aureus.
 Gonococcal infection affecting the urethra or cervix.
 Re-infection by strept, staph and E. coli spreading
through the uterine canal into the tube and fimbriac.
 Tuberculosis i.e. tubercle bacilli and anaerobic
bacteria can be causative agents.

4. RISK FACTORS
 Risk of PID increases if one has gonorrhoea or Chlamydia
although an individual can develop PID without having an
STI. Other factors that can predispose one to the
development of the infection include:
 Multiple sexual partners
 Early initiation of sexual intercourse
 Unprotected sex
 Use of IUCD
 Douching
 Previous history of PID

5. SPREAD
 By blood-borne along the surface of endometrium to
the fallopian tubes and into the peritoneum.
 By lymphatic channels, uterine veins or fallopian tube
and produces pelvic cellulitis.
 If by tubercle bacilli, usually by way of blood stream
through the legs.

6. SIGNS/SYMPTOMS
 Fever and chills
 Malaise
 Anorexia
 Abdominal pain especially lower abdomen
 Nausea and vomiting
 Presence of leucorrhoea
 Heavy and purulent discharge in the case of
Gonococcal and staph infections. Then thinner and
more mucoid discharge in strept infections.

7. CONT
 Painful micturation
 Dyspareunia
 Irregular bleeding

8. INVESTIGATIONS
 High vaginal swab for m/c/s.
 Ultrasound scan which may reveal excess collection of
fluid in the pouch of Douglas.
 Urine M/C/S
 FBC

9. MANAGEMENT
 Patient is usually admitted and may or may not be isolated
depending on the cause of her infection.
 Patient is placed on bed rest in a semi-recumbent position.
This is to promote drainage of discharge (pus) into the
vagina.
 Vulva toilet should be done as needed to keep patient clean
and comfortable.
 Perineal pads should be handled carefully with
instruments or gloves and disposed of properly.
 Proper disinfection of all articles used on the patient; bed
pan, toilet seats, linen e.t.c.

10. CONT
 Catheterization and use of tampons should be
avoided.
 External heat to the lower back and abdomen may be
given for soothing.
 Medication:- analgesic may be given.
 Antibiotics may be given following culture and
sensitivity.
 Check and record vital signs. In cases of prolonged
debilitating infections which are resistant to
conservative treatment, salpingectomy or
hysterectomy may be done.

11. COMPLICATIONS
 Infertility from occluded fallopian tubes or fimbriac.
 Ovarian distortion due to adhesions
 Chronic pelvic pain
 Ectopic pregnancy
 Tubo-ovarian abscess