PELVIC INFLAMMATORY DISEASE

 

INTRODUCTION: Pelvic inflammatory disease (PID) is an inflammatory condition of the pelvic cavity that may begin with cervicitis and may involve the uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum, or pelvic system. Infection, which may be acute, subacute, recurrent, or chronic and localized or widespread, is usually caused by bacteria but may be attributed to a virus, fungus, or parasite. 

PATHOPHYSIOLOGY: Pathogenic organisms usually enter the body through the vagina, pass through the cervical canal into the uterus, and may proceed to one or both fallopian tubes and ovaries, and into the pelvis. Infection most commonly occurs through sexual transmission but also may be caused by invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device (IUD). The most common organisms involved are gonorrhea and chlamydia. The infection is usually bilateral.

RISK FACTORS: Risk factors include early age at first intercourse, multiple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with a sexually transmitted disease (STD), and a history of STDs or previous pelvic infection.

CLINICAL MANIFESTATIONS: Symptoms may be acute and severe or low-grade and subtle. Vaginal discharge, dyspareunia, lower abdominal pelvic pain, and tenderness that occurs after menses; pain increases during voiding or defecating. Systemic symptoms include fever, general malaise, anorexia, nausea, headache, and possibly vomiting. Intense tenderness is noted on palpation of the uterus or movement of cervix (cervical motion tenderness) during pelvic examination.

COMPLICATIONS: Pelvic or generalized peritonitis, abscesses, strictures, and fallopian tube obstruction. Adhesions that eventually may require removal of the uterus, tubes, and ovaries. Bacteremia with septic shock and thrombophlebitis with possible embolization.

MEDICAL MANAGEMENT: Broad-spectrum antibiotic therapy is instituted, with mild to moderate infections being treated on an outpatient basis. If the patient is acutely ill, hospitalization may be required. Once hospitalized, the patient is placed on a regimen of bed rest, IV fluids, and IV antibiotic therapy. Nasogastric intubation and suction are used if ileus is present; vital signs are monitored. Treatment of sexual partners is necessary to prevent reinfection.

RELATED;

1. BACTERIOLOGY  

2. ANTIBIOTICS  

3.  MEDICINE AND SURGERY

4.  OBSTETRICS AND GYNECOLOGY

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