Pelvic inflammation disease and their management

1. PELVIC INFLAMMATORY
DISEASE
Dr. Yashika

2. Definition
 PID is a disease of the upper genital tract.
 It is a spectrum of infection and
inflammation of the upper genital tract
organs typically involving the uterus
(endometrium), fallopian tubes, ovaries,
pelvic peritoneum and surrounding
structures.

3. Epidemiology
 Occurs both in the developed and developing
countries.
 85 per cent are spontaneous infection in
sexually active females of reproductive age.
 The remaining 15 per cent follow procedures,
which favors the organisms to ascend up.
 Two-thirds are restricted to young women of
less than 25 years and the remaining one-third
limited among 30 years or older.

4. Risk factors
 Menstruating teenagers.
 Multiple sexual partners.
 Absence of contraceptive pill use.
 Previous history of acute PID.
 IUD users.
 Area with high prevalence of sexually
transmitted diseases.

5. Protective factors
 „
Contraceptive practice
Barrier methods
Oral steroidal contraceptives
Monogamy / Vasectomy
 „
Others
Pregnancy
Menopause
Vaccines

6. CLINICAL FEATURES
 Bilateral lower abdominal and pelvic pain dull
in nature.
 Fever, lassitude and headache.
 •
•
Irregular and excessive vaginal bleeding .
 Abnormal vaginal discharge (purulent or
copious)
 •
•
Nausea and vomiting.
 •
•
Dyspareunia.
 •
•
Pain and discomfort in the right
hypochondrium.

7. Signs
 Temperature >38.3°C.
 •
•
Abdominal palpation
(1) Tenderness on both the quadrants of lower abdomen.
(2) The liver may be enlarged and tender.
 •
•
Vaginal examination
(1) Abnormal vaginal discharge (purulent).
(2) Congested external urethral meatus or openings of Bartholin’s ducts
through which pus may be seen escaping out on pressure.
(3) Speculum examination shows congested cervix with purulent discharge
from the canal.

8. Clinical diagnostic criteria of PID
(CDC-2006)
 Minimum Criteria
Lower abdominal tenderness.
Adnexal tenderness.
Cervical motion tenderness.
 •
•
Additional Criteria
Oral temperature > 38.3°C.
Mucopurulent cervical or vaginal discharge.
Raised C-reactive protein and/or ESR.
 Definitive Criteria
Histopathologic evidence of endometritis on biopsy.
Imaging study (TVS/MRI) evidence of tubo-ovarian complex.
Laparoscopic evidence of PID

9. Investigations
 Identification of organisms
 Blood: Leucocyte count shows
leucocytosis to more than 10,000 per cu mm
and an elevated ESR value of more than 15
mm per hour.
 Laparoscopy

10. Complications Of Pid
Immediate
1) Pelvic peritonitis or even generalized
2) Septicemia
Late
(1) Dyspareunia
(2) Infertility
(3) Chronic pelvic inflammation
(4) Formation of adhesions or hydrosalpinx or pyosalpinx and tubo-
ovarian abscess.
(5) Chronic pelvic pain and ill health.

11. Ambulatory Management Of Acute PID
(CDC-2006)
Patient should have oral therapy for 14 days
 „Regimen A
Levofloxacin 500 mg (or, ofloxacin 400 mg)
PO
Metronidazole 500 PO bid
 „Regimen B
Ceftriaxone 250 mg IM single dose
Doxycycline 100 mg PO BID with or without
Metronidazole 500 mg PO BID for 14 days

12. Inpatient Antibiotic Therapy
(CDC–2006)
Regimen A
Cefoxitin 2 gm iv every 6 hours for 2-4 days
„Doxycycline 100 mg Po for 14 days
Regimen B
„Clindamycin 900 mg iv every 8 hours
„Gentamicin 2 mg/kg iv
Alterntive regimen
„
Levofloxacin 500 mg iv
Metronidazole 500 mg iv

13. Thank you