This document provides information on pelvic inflammatory disease (PID), including its definition, epidemiology, risk factors, clinical features, treatment approaches, and preventative measures. It defines PID as an infection and inflammation of the upper female genital tract that can involve the uterus, fallopian tubes, ovaries, and surrounding structures. Key points include: - PID is usually caused by the ascending spread of bacteria from the vagina to the pelvic organs. - The incidence is increasing due to rising sexually transmitted infections, ranging from 1-2% annually in sexually active women. - Risk factors include multiple sexual partners and a history of STIs. - Clinical features include abdominal and pelvic pain, fever

1. THERAPEUTICS – PELVIC
INFLAMMATORY DISEASE (PID)
DR. D. Y. PATIL HOMOEOPATHIC MEDICAL COLLEGE
AND RESEARCH CENTRE
DR. RADHIKHA KHANDELWAL
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

2. DEFINITION
PID 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.
● It is attributed to the ascending spread of microorganisms from
the cervicovaginal canal to the contiguous pelvic structures
causing endometritis, salpingitis, pelvic peritonitis or tubo-ovarian
abscess.
The cervicitis is not included in the list.
● The clinical syndrome is not related to pregnancy and surgery.

4. EPIDEMIOLOGY
● The incidence of pelvic infection is on the rise due to the rise in sexually
transmitted diseases.
● The incidence varies from 1–2 percent per year among sexually active
women.

5. EPIDEMIOLOGY
85%
15%
Following
procedure
s
Spontaneous
infection in
sexually active
females
● About 85% are
spontaneous infection in
sexually active females
of
reproductive age.
● The remaining 15%
follow procedures
(include endometrial
biopsy, uterine curettage,
insertion of IUD and
hysterosalpingography.

6. 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.

7. PROTECTIVE FACTORS
Contraceptive practice
● Barrier methods, specially condom, diaphragm
with spermicides.
● Oral steroidal contraceptives have got two
preventive aspects.
○ Produce thick mucus plug preventing
ascent of sperm and bacterial penetration.
○ Decrease in duration of menstruation,
creates a shorter interval of bacterial colo-
nization of the upper tract.
● Monogamy or having a partner who had
vasectomy.
Others
● Pregnancy
● Menopause
● Vaccines: hepatitis B,
HPV

8. CLINICAL FEATURES
Symptoms
● Patients with acute PID present with a wide range of non-specific
clinical symptoms.
● Symptoms usually appear at the time and immediately after the
menstruation.
● Bilateral lower abdominal and pelvic pain which is dull in nature.
The onset of pain is more rapid and acute in gonococcal infection
(3 days) than in chlamydial infection (5–7 days).
● There is fever, lassitude and headache.
● Irregular and excessive vaginal bleeding is usually due to
associated endometritis.
● Abnormal vaginal discharge which becomes purulent and or
copious.

9. CLINICAL FEATURES
Symptoms
● Nausea and vomiting.
● Dyspareunia.
● Pain and discomfort in the right hypochondrium due to concomitant
perihepatitis (Fitz-Hugh-Curtis syndrome) may occur in 5–10% of
cases of acute salpingitis.
● The liver is involved due to transperitoneal or vascular
dissemination of either gonococcal or chlamydial
infection.

10. CLINICAL FEATURES
Signs
● The temperature is elevated to beyond 38.3°C.
● Abdominal palpation reveals tenderness on both the quadrants of lower
abdomen. The liver may be enlarged and tender.
● Vaginal examination reveals:
(1) Abnormal vaginal discharge which may be of 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.
(4)Bimanual examination reveals bilateral tenderness on fornix
palpation, which increases more with movement of the cervix. There
may be thickening or a definite mass felt through the fornices.

11. CLINICAL FEATURES

12. CLINICAL DIAGNOSTIC CRITERIA OF PID (CDC 2015)
Minimum Criteria
1. Adnexal tenderness.
2. Cervical motion tenderness.
3. Uterine tenderness
Definitive Criteria
1. Endometrial biopsy with histopathologic evidence of endometritis;
2. Transvaginal sonography or magnetic resonance imaging techniques showing
thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian
complex, or Doppler studies suggesting pelvic infection (e.g., tubal hyperemia);
3. Laparoscopic findings consistent with PID.
Additional Criteria
1. Oral temperature >101°F (>38.3°C);
2. Abnormal cervical mucopurulent discharge or
cervical friability;
3. Presence of abundant numbers of WBC on
saline microscopy of vaginal fluid;
4. Elevated ESR;
5. Elevated CRP;
6. laboratory documentation of cervical infection
with N. gonorrhoeae or C. trachomatis.

13. TREATMENT
To prevent reinfection.
3
To prevent infertility and late sequelae.
02
01 THE
PRINCIPLES
OF
THERAPY
To control
the infection
energetically.
To prevent
infertility and
late
sequelae.
To prevent
reinfection

14. HOMOEOPATHIC APPROACH
• Pain in abdomen
• Any history of fever
• P/V discharge
CHIEF COMPLAINTS
MENSTRUAL HISTORY
OBSTETRIC HISTORY
RECENT EVENT OF INTERCOURSE/UNPROTECTED SEX

15. HOMOEOPATHIC REMEDIES
• APIS MELLIFICA
•CALADIUM
•PLATINA
•SEPIA
•NATRUM MURIATICUM
•CALCAREA CARBONIA
•CANTHARIS
•PALLADIUM
•PULSATILLA
•HYDRASTIS
•BELLADONNA

16. APIS MELLIFICA
MENTALS
• Drops things when
handling them.
• Irritable, nervous;
extremely sensitive to
touch.
• Feels as if every breath
would be his last.
• Desires cold things –
cold air, cold milk.
• Delirium, after
suppressed scarlet
eruption.
GENERALS
• Right sided remedy –
symptoms go from
right to left.
• Aversion to tight
bandaging.
• THERMALLY – Hot.
• TEMPERAMENT –
Irritable.
• MIASM – Psora.
• Thirstless remedy.
• Remittent fever when
inflammation is
present.
• Continuous and low
type of fever.
PARTICULARS
• Oedema of labia; amil –
cold water.
• Oophoritis/salphingitis
with burning stinging
pain, worse in right
ovary.
• Great tenderness over
abdominal and uterine
region.
• Metrorrhagia; sense of
tightness.
• Dysmenorrhoea with
severe ovarian pain.
MODALITIES
• AGGRAVATION – after
sleep; closed warm
room; getting wet;
touch; pressure; 3pm;
right side.
• AMELIORATION – Open
air; uncovering; cold
bathing; changing
position.

17. CALADIUM
MENTALS
• Sensitive to noise.
• Destroys craving for
tobacco.
PARTICULARS
• Pruritus – vagina inducing
onanism (masturbation),
especially during
pregnancy with mucous
discharge.
• Inflammation of vagina
and parts are sore.
• Sebaceous cysts around
parts.
• Crawling sensation in
vagina.
• Parts are dry, scaly with
violent corrosive itching.
MODALITIES
• AGGRAVATION – motion,
from warmth.
• AMELIORATION – from
sweat, after short sleep,
cold water.

18. PLATINA
MENTALS
• Pride and over
estimation.
• Superiority complex.
• Females are very much
arrogant, proud and
naughty.
• Anxious and serious over
silly matters.
• Fear of death, fears that
something serious will
happen to her.
• MENTAL SYMPTOMS
APPEAR AS PHYSICAL
SYMPTOM DISAPPEAR
AND VICE-VERSA.
GENERALS
• AILMENTS FROM –
Mental disturbances after
fright, grief, vexation,
onanism, pride, sexual
excess.
• THERMALLY – Hot.
• TEMPERAMENT –
Hysterical/sanguine.
• MIASM – Psora.
• Hysterical females.
PARTICULARS
• Metrorrhagia &
Menorrhagia, menses too
early, too profuse, too
long lasting with dark
clotted, black blood with
spasm of uterus.
• Pain comes gradually &
goes gradually.
• Genital organs are
exceedingly sensitive; she
cannot bear even the
napkin to touch her
private parts; patient can
go into spasm from an
examination.
• NYMPHOMANIA –
Vaginismus with spasm &
constriction; hence
cannot endure coition.
MODALITIES
• AGGRAVATION – sitting,
standing, evening.
• AMELIORATION – by
walking in open air.

19. SEPIA
MENTALS
• Excessively nervous.
• Indifferent to
everything –
occupation, work,
family, loved ones.
• Cannot narrate her
symptoms without
weeping.
• Consolation aggravates
her mentals.
• Depressed, anxious and
fearful state, with a
sense of helplessness;
frequent attacks of
weeping and despair of
life.
GENERALS
• AILMENTS FROM –
Exposure to cold,
laundary work, alcohol,
tobacco, wetting,
before and druing
menses, after eating,
going upstairs, coitus,
change of weather, cold
air, milk, acids, fats,
before thunderstorm.
• THERMALLY – Chilly
• TEMPERAMENT –
Nervous
• MIASM – Psora and
sycosis.
PARTICULARS
• All kind of menstrual
irregularities are found
in Sepia, associated
with other uterine and
genital complaints.
• Bearing down pressure
from back to abdomen.
• Must cross legs to
prevent protrusion of
parts.
• Complete absence of
sexual desire.
• Yellowish, greenish
with much itching,
acrid leucorrhea before
menses, causes
soreness of pudenda.
MODALITIES
• AGGRAVATION –
morning, evening,
washing, laundry,
dampness, left side,
after sweat, cold air,
before a thunderstorm.
• AMELIORATION –
exercise, pressure,
warmth of bed, hot
application, cold
bathing, after sleep.

20. NATRUM MURIATICUM
MENTALS
•Excessive irritability.
•Hysterical condition
of mind, weeping
alternates with
laughing.
•Consolation
aggravates the state
of mind.
•Hypochondriacal
mood & lachrymal
disposition.
•Dreams of robbers
at night.
GENERALS
•THERMALLY – Hot.
•TEMPERAMENT –
Nervous.
•MIASM – All the
three miasm.
PARTICULARS
•First menses
delayed.
•Irregular menses,
which can be too
late or too early or
too scanty or too
profuse.
•Bearing down pain
in uterus, which is
worse in morning.
•Sterility.
•Fever with
periodicity is well
marked.
MODALITIES
•AGGRAVATION –
sunrise to sunset,
especially from
10am to 11am,
seashore, heat of
sun, mental
exertion, lying
down, consolation.
•AMELIORATION –
open air, cold
bathing, going
without regular
meals, lying right
side.

21. PREVENTION
The following formalities are to be rigidly followed to prevent reinfection:
● Educating the patient to avoid reinfection and the potential hazards of it.
● The patient should be warned against multiple sexual partners.
● To use condom.
● The sexual partner or partners are to be traced and properly investigated
to find out the organism(s) and treated effectively. If they have got non-
gonococcal urethritis, they should be treated with tetracycline 500 mg 6
hourly or doxycycline 100 mg twice daily for 7 days.

22. Thank You