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Pelvic Inflammatory Disease

PID

Pelvic inflammatory disease, abbreviated as PID, is a condition characterized by inflammation of the uterus, fallopian tubes and ovaries. 


Presentation

Most often, PID does not produce any signs and symptoms in the early stages. When the disease progresses to more advance stages, the following symptoms are evident [7]:

  • Fever
  • Pain during intercourse
  • Heavy menstrual bleeding
  • Irregular menstrual cycle
  • Foul smelling vaginal discharge
  • Pain in the pelvic and lower abdomen
  • Pain while urinating 
  • Increase in the frequency of urination 

In addition to the above mentioned symptoms, affected women would also experience nausea, vomiting, tiredness, bleeding after intercourse and poor appetite [8]. 

Fever
  • The triad of fever, leukocytosis, and diarrhea was positively related to the presence of TOA. The triad of fever, leukocytosis, and diarrhea should alert clinicians to the possibility of TOA formation in patients with PID.[ncbi.nlm.nih.gov]
  • All three patients presented with an acute abdomen, fever and elevated white blood cell count. Our experience suggests that PID following tubal sterilization is more common than previously described and can present a diagnostic dilemma.[ncbi.nlm.nih.gov]
  • We report the case of a 30-year-old housewife who presented with fever and lower abdominal pain, and was diagnosed with an adnexal collection. Initial evaluation was suggestive of tubercular pelvic inflammatory disease (PID).[ncbi.nlm.nih.gov]
  • We present a 14-year-old, menarchal, non-sexually active female with a 3-week history of abdominal pain and fever. Surgical exploration and cultures revealed Stage IV pelvic inflammatory disease caused by Beta Streptococcus Group F.[ncbi.nlm.nih.gov]
  • A 49-year-old woman presented with pelvic pain, fever (38 degrees C), elevated white blood cell count and a right adnexal mass. Pelvic inflammatory disease was suspected and broad spectrum antibiotics were established.[ncbi.nlm.nih.gov]
Chills
  • Symptoms include pain, cramping, chills, spotting, and nausea. Pelvic Inflammatory Disease (PID) Menu Overview What is pelvic inflammatory disease (PID)? Pelvic inflammatory disease (PID) is an infection of the female reproductive organs.[my.clevelandclinic.org]
  • PID can cause pelvic pain, abdominal tenderness, vaginal discharge, fever, chills, and pain during urination and sex. Treatment includes antibiotics, especially if you have a STD.[hopkinsmedicine.org]
  • They include pain in the abdomen and lower pelvis, chills, nausea, fever , and a thick and peculiarly odorous vaginal discharge. The major complication of PID is scarring of the fallopian tubes , with infertility often a consequence.[britannica.com]
  • PID can cause pelvic pain, belly tenderness, vaginal discharge, fever, chills, and pain during urination and sex. Treatment includes antibiotics, especially if you have a STD.[urmc.rochester.edu]
High Fever
  • A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter.[ncbi.nlm.nih.gov]
  • fever Nausea and vomiting Pain during sex Cleveland Clinic News & More Cleveland Clinic News & More[my.clevelandclinic.org]
  • fever), inability to follow a proposed outpatient regimen, as well as failure to respond to prescribed oral antibiotics with persistent or worsening symptoms.[news-medical.net]
  • However, some women have severe pain and symptoms, such as: sharp pain in the abdomen vomiting fainting a high fever (greater than 101 F) If you have severe symptoms, call your doctor immediately or go to the emergency room.[healthline.com]
Malaise
  • I had severe menstrual irregularities, fevers, bleeding between periods, bleeding after intercourse, pains, and general malaise. Several times I was treated with antibiotics, which brought only some temporary relief.[ourbodiesourselves.org]
  • Patients may also present with fever, nausea, vomiting and general malaise, but this is variable and may range from minimally symptomatic to toxic appearing.[cdemcurriculum.com]
  • Symptoms typically include progressive lower abdominal pain with guarding and rebound tenderness, fever, copious purulent cervical discharge, nausea and vomiting, malaise, urinary urgency and frequency, vaginal itching, and maceration.[medical-dictionary.thefreedictionary.com]
Abdominal Pain
  • This rare diagnosis of peri-implantation pelvic inflammatory disease should be considered in the differential diagnosis of abdominal pain in early pregnancy.[ncbi.nlm.nih.gov]
  • A 64 year old female presented was admitted with the principal complaints of fever, lower abdominal pain and malodorous vaginal discharge.[ncbi.nlm.nih.gov]
  • PID in virgin women is rare, but it should be considered in all women with abdominal pain, regardless of sexual history.[ncbi.nlm.nih.gov]
  • Albendazole treatment cleared the infestation but the patient suffered subsequent bouts of lower abdominal pain. The literature is reviewed regarding abdominal pathology associated with ectopic migration of pinworms.[ncbi.nlm.nih.gov]
  • Severe pelvic inflammatory disease and peritonitis should be included in the differential diagnosis of patients presenting with significant abdominal pain following Falope Ring tubal ligation.[ncbi.nlm.nih.gov]
Vomiting
  • If nausea and vomiting are present, this suggests peritonitis .[almostadoctor.co.uk]
  • Symptoms may include painful periods or urination, a dull pain in your lower abdomen, yellow or green odorous vaginal discharges, fever, chills, or vomiting. PID can be treated with antibiotics.[sharecare.com]
  • […] extremely careful if you notice any of the following: Symptoms of PID Cramping, pain, or tenderness in the pelvic or lower abdominal (stomach) area Bleeding between periods Increased or different discharge from your vagina Pain when having sex Nausea and/or vomiting[iwannaknow.org]
  • Get medical help right away if you have: Severe pain in your lower belly Signs of shock, like fainting Vomiting Fever higher than 101 F Some of these also can be signs of other serious medical conditions, like appendicitis or an ectopic pregnancy (a pregnancy[webmd.com]
Nausea
  • Common treatment-related adverse events were diarrhoea, injection site pain, and nausea. All adverse events were mild or moderate in severity.[ncbi.nlm.nih.gov]
  • In addition, affected women also suffer from fever, nausea and loss of appetite. Diagnosis Preliminary examination of pelvic region through imaging studies and physical examination is required to evaluate the underlying condition.[symptoma.com]
  • If nausea and vomiting are present, this suggests peritonitis .[almostadoctor.co.uk]
  • Symptoms include pain, cramping, chills, spotting, and nausea. Pelvic Inflammatory Disease (PID) Menu Overview What is pelvic inflammatory disease (PID)? Pelvic inflammatory disease (PID) is an infection of the female reproductive organs.[my.clevelandclinic.org]
Chronic Abdominal Pain
  • Clinical presentations include postmenopausal bleeding, lower abdominal mass, chronic abdominal pain and menorrhagia. We present a case of small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease.[ncbi.nlm.nih.gov]
  • When PID is treated early, it greatly reduces the risk of complications like lower fertility, chronic abdominal pain , ectopic pregnancy (foetus development in the fallopian tubes), miscarriage , premature birth and stillbirth .[healthdirect.gov.au]
  • Other complications of PID are bacteremia with septic shock, thrombophlebitis with the possibility of an embolus, chronic abdominal pain, and pelvic adhesions. Causes The causes of PID vary by geographic location and population.[medical-dictionary.thefreedictionary.com]
  • If a pregnancy occurs following an ectopic pregnancy, the rate of another ectopic pregnancy is about 20%. 20 Chronic Abdominal Pain Chronic abdominal pain lasting longer than 6 months occurred in 17–18% of women after one or more episodes of PID, compared[glowm.com]
Severe Abdominal Pain
  • All our patients presented with an acute onset of severe abdominal pain and had an intrauterine device (IUD) present. No abnormal sexual behavior was noticed.[ncbi.nlm.nih.gov]
  • If you develop severe abdominal pain, you should go to your local A&E department, but for all other symptoms, a prompt diagnosis is just as important.[onlinedoctor.superdrug.com]
  • As the infection gets worse, you may have severe abdominal pain, fever, and vomiting. If you notice these or any other unusual symptoms, it's a good idea to talk to your doctor right away.[sharecare.com]
  • PID Inflammation of the female genital tract, especially of the fallopian tubes, caused by any of several bacteria, chiefly chlamydia and gonococci, and characterized by severe abdominal pain, high fever, vaginal discharge, and in some cases destruction[medical-dictionary.thefreedictionary.com]
Low Back Pain
  • Very occasionally there may be pain in the upper abdomen, and low back pain may occur too. The monthly periods may be altered.[medinfo.co.uk]
  • Low back pain. Painful urination. Some women who have PID do not experience these symptoms and do not know they have it. If you have the above symptoms, or if you think you have been exposed to an STI, call your doctor.[familydoctor.org]
  • Low back pain . Symptoms may develop quickly. You can become quite ill over a few days. Sometimes symptoms are mild and develop slowly. For example, you may just have a mild abdominal pain that may 'grumble on' for weeks.[patient.info]
Pelvic Pain
  • Despite treatment with broad-spectrum parenteral antibiotics, the patient remained febrile with persistent pelvic pain.[ncbi.nlm.nih.gov]
  • Pelvic inflammatory disease (PID) is often responsible for acute pelvic pain, yet its clinical diagnosis is difficult.[ncbi.nlm.nih.gov]
  • Chronic pelvic pain is a main symptom of BPS/IC, and chronic inflammation is a major etiology of BPS/IC.[ncbi.nlm.nih.gov]
  • It can also cause chronic pelvic pain and ectopic pregnancy.[livescience.com]
  • Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy.[ncbi.nlm.nih.gov]
Vaginal Discharge
  • Culture of the vaginal discharge revealed the presence of E. coli.[ncbi.nlm.nih.gov]
  • Four other variables were used to build another model that predicted PID with high specificity: abnormal vaginal discharge, bilateral pelvic pain, constipation, and presence of an intrauterine device.[ncbi.nlm.nih.gov]
  • Nucleic acid amplification testing from vaginal discharge was positive for C. trachomatis and Trichomonas vaginalis and negative for Neisseria gonorrhoeae.[ncbi.nlm.nih.gov]
  • Common symptoms are lower abdominal or pelvic pain, fever, vaginal discharge and pain or bleeding with intercourse.[sharecare.com]
  • discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months.[ncbi.nlm.nih.gov]
Salpingitis
  • We estimated that for women aged 35-44 years, 33·6% and 16·1% have experienced at least one episode of PID and salpingitis, respectively (diagnosed or not) and 10·7% have experienced one salpingitis and no further PID episodes, 3·7% one salpingitis and[ncbi.nlm.nih.gov]
  • Its association with chronic active follicular salpingitis has not been previously reported.[ncbi.nlm.nih.gov]
  • Since salpingitis during pregnancy, like salpingitis generally, is amenable to antibiotic therapy, surgery may be avoided if appropriate antibiotic therapy is quickly instituted.[ncbi.nlm.nih.gov]
  • Omental/mesenteric fat infiltration and salpingitis can be strongly related with perihepatitis in PID.[ncbi.nlm.nih.gov]
  • A case of E. vermicularis-associated pelvic inflammatory disease with right salpingitis mimicking acute abdomen due to appendicitis in an 11-year-old girl is presented.[ncbi.nlm.nih.gov]
Cervical Motion Tenderness
  • Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness.[ncbi.nlm.nih.gov]
  • Bimanual examination revealed cervical motion tenderness with a WBC of 9400 cells/microL and increased levels of neutrophils, band cells and C-reactive protein. Sonography revealed an adnexal echocomplex compatible with tubo-ovarian abscess.[ncbi.nlm.nih.gov]
  • Empiric antibiotic therapy should be initiated in all women at risk who have uterine, adnexal, or cervical motion tenderness on a bimanual exam with no other explanation for these symptoms.[ncbi.nlm.nih.gov]
  • Symptoms and physical findings vary widely and may include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Fever and cervical or vaginal discharge may also be present.[bestpractice.bmj.com]
Adnexal Tenderness
  • Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness.[ncbi.nlm.nih.gov]
  • The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. Cervical motion, uterine, and lower abdominal tenderness may also be present.[cdemcurriculum.com]
  • Symptoms and physical findings vary widely and may include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Fever and cervical or vaginal discharge may also be present.[bestpractice.bmj.com]
  • tenderness INVESTIGATIONS bloods for infection first pass urine - Chlamydia PCR MSU - rule out UTI high vaginal swab (gonorrhoea) Bacteria Chlamyophilia trachomatis Neisseria gonorrhoea Mycoplasma hominis Ureaplasma urealyticum Actinomyces (if IUD in[lifeinthefastlane.com]

Workup

Various tests are indicated to confirm PID as well as to evaluate the extent of spread of the disease condition. The following methods are carried out to diagnose the condition [9]:

  • Physical examination: A preliminary physical examination to study the signs and symptoms of the disease is done. A thorough pelvic examination is also carried out to study tenderness in the uterus, ovaries or fallopian tubes. Pelvic examination would also reveal bleeding from the cervix, pain in the cervix and presence of fluid discharge from the area.
  • Laboratory tests: Samples from the cervix and vagina are collected through swabs to test for the type of organism involved. In addition, various laboratory tests such as WBC count, erythrocyte sedimentation rate and C-reactive protein tests will be conducted to check for signs of infections.
  • Ultrasound: Imaging studies such as ultrasound examination would provide knowledge on the extent of spread of the infection to the reproductive organs.
  • Endometrial biopsy is done for further analysis of PID.
Nephrolithiasis
  • […] disease or dysfunction (complications of pregnancy, acute infections, endometriosis, adnexal disorders, menstrual disorders), as well as gastrointestinal (appendicitis, gastroenteritis, inflammatory bowel disease), genitourinary (cystitis, pyelonephritis, nephrolithiasis[canada.ca]
  • ., urinary tract infection/pyelonephritis, nephrolithiasis); obstetric/gynecologic conditions (e.g., ovarian tumor/cyst/torsion, ectopic pregnancy); or functional pelvic pain. Enlarge Print Table 1.[aafp.org]
  • […] when evaluating a patient with suspected PID -Ectopic -Intrauterine Gynecologic Pathology: -Bacterial vaginosis -Yeast vulvovaginitis -Uterine fibroids -Endometriosis -Ovarian cysts -Ovarian torsion Genitourinary disorders: -Urinary tract infections -Nephrolithiasis[clinicaladvisor.com]
Elevated Sedimentation Rate
  • Erythrocyte sedimentation rate (ESR) — The rate at which red blood cells settle out in a tube of unclotted blood, expressed in millimeters per hour; elevated sedimentation rates indicate the presence of inflammation.[medical-dictionary.thefreedictionary.com]
  • Insistence on rigid diagnostic criteria such as fever, abdominal tenderness, leukocytosis, and an elevated sedimentation rate can uncover only the most overt cases of PID while excluding most cases.[glowm.com]

Treatment

The following methods are employed for treatment of PID [10]:

  • Antibiotic medications: Upon diagnosis, the patient is put on an antibiotic regime. Based on the lab results confirming the causative organism, the dosage or the type of antibiotic to be administered is decided.
  • Partner’s treatment: The partner of the affected woman would also require treatment. This is essentially done to prevent reinfection of the disease. 
  • Practice abstinence: It is necessary to avoid sexual intercourse until laboratory tests reveal that both the partners are not carrying any more pathogenic organisms.
  • Surgery is rarely indicated in patients with PID. However when antibiotics fail to work or an abscess ruptures then surgery may be necessary.

Prognosis

The prognosis of the condition would gravely depend on when the diagnosis was made and treatment initiated. Many women with PID are completely unaware of the fact that they are living with a disease condition unless they experience severe symptoms. In such conditions, PID progresses to the advance stages causing chronic pelvic pain, infertility or ectopic pregnancy [6].

Etiology

Sexually transmitted infections are the most common cause of PID. The bacteria responsible for causing such a kind of infection are gonorrhea and chlamydia. Statistical data has shown that, 10 to 20% of untreated infections caused by gonorrhea and chlamydia can progress to pelvic inflammatory disease [2]. However, these bacteria can also gain entry to the body during the process of childbirth, abortion, miscarriage and endometrial biopsy. Women who get an intrauterine device (IUD) inserted are also at an increased risk of contracting infection from the bacteria [3].

In addition to gonorrhea and chlamydia, other organisms that are responsible for causation of PID include streptococcus agalactiae, trichomonas vaginalis, ureaplasma urealyticum, mycoplasma hominis and herpes simplex virus 2 to name a few.

Epidemiology

The incidence of pelvic inflammatory disease is on the rise owing to increase in number of cases related to sexually transmitted diseases. It has been estimated that about 1 in every 8 women who are younger than 20 years and are sexually active will develop PID. In the United States, about 1 million women suffer from PID each year. The disease causes about 2.5 million outpatient visits and 125,000 to 150,000 hospitalization every year. The rate of pelvic inflammatory amongst the high income population is known to be about 10 to 20 per 1000 women in the reproductive age group. The annual expense of PID has been calculated to be about $2 billion [4].

Sex distribution
Age distribution

Pathophysiology

Pelvic inflammatory disease is thought to occur in 2 distinct stages. The primary stage, wherein the vaginal infection is acquired through sexually transmitted disease. In the secondary stage, the bacteria travel from the vagina to the reproductive organs causing infection and inflammation of the concerned organs. The exact mechanism that triggers such sequence of events is still not well understood.

Under normal conditions, the travel of the bacteria or spread of the infection to the upper genital tract is prevented by the mucus barrier of the cervix. However, certain factors such as vaginal inflammation and hormonal changes that occur during menstruation may decrease the effectiveness of the functional barrier of the cervical mucus [5].

Prevention

Following are the several ways by which the risk of contracting PID can be significantly reduced:

  • Women are advised to practice safe sex and limit number of partners. Use of proper contraception can also help decrease the risk of contracting infections.
  • Women who are sexually active should regularly get screened for sexually transmitted diseases. They should also get their partners regularly tested for sexually transmitted infections. This would go a long way in prevention of PID.
  • Douching upsets the balance of vaginal microflora. Such a practice should therefore be discouraged.

Summary

Pelvic inflammatory disease (PID) occurs when sexually transmitted disease is left untreated as a result of which an infection spreads from the vagina to the uterus, fallopian tubes and ovaries. The disease seldom produces any signs and symptoms and is diagnosed in the later stages when the affected woman complains of pelvic pain or is facing difficulty in conceiving [1].

Patient Information

Definition

Pelvic inflammatory disease (PID) is defined as a condition wherein the female reproductive organs undergo inflammation due to infection. It is a common phenomenon for sexually active females under 20 years of age. Sexually transmitted infections can predispose women to contract PID.

Cause

Bacterial infections responsible for causing sexually transmitted diseases are the most common cause of PID. Bacteria such as gonorrhea and chlamydia cause PID.

Symptoms

Symptoms of PID include pelvic pain, pain in the lower abdominal region, foul vaginal discharge, increased urge to urinate, pain during urination, pain during intercourse and irregular menstruation. In addition, affected women also suffer from fever, nausea and loss of appetite.

Diagnosis

Preliminary examination of pelvic region through imaging studies and physical examination is required to evaluate the underlying condition. Laboratory tests and swabs from cervix are carried out to determine the causative organism.

Treatment

PID is treated through antibiotic course. Surgery is seldom required, but in case when antibiotics did not work or an abscess has ruptured it becomes a necessity.

References

Article

  1. Owusu-Edusei K Jr, Bohm MK, Chesson HW, Kent CK. Chlamydia screening and pelvic inflammatory disease: Insights from exploratory time-series analyses. Am J Prev Med 2010; 38:652.
  2. Herzog SA, Althaus CL, Heijne JC, Oakeshott P, Kerry S, Hay P, et al. Timing of progression from Chlamydia trachomatis infection to pelvic inflammatory disease: a mathematical modelling study. BMC Infect Dis. Aug 11 2012;12:187.
  3. Meirik O. Intrauterine devices - upper and lower genital tract infections. Contraception. 2007;06;75 (6 Suppl/):S4
  4. Washington AE, Katz P. Cost of and payment source for pelvic inflammatory disease. Trends and projections, 1983 through 2000. JAMA 1991; 266:2565.
  5. Galask RP, Larsen B, Ohm MJ. Vaginal flora and its role in disease entities. Clin Obstet Gynecol 1976; 19:61.
  6. Ness RB, Smith KJ, Chang CC, Schisterman EF, Bass DC. Prediction of pelvic inflammatory disease among young, single, sexually active women. Sex Transm Dis. Mar 2006;33(3):137-42.
  7. Wølner-Hanssen P. Silent pelvic inflammatory disease: is it overstated? Obstet Gynecol 1995; 86:321.
  8. Peipert JF, Ness RB, Blume J, et al. Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Am J Obstet Gynecol 2001; 184:856.
  9. Jacobson L, Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol 1969; 105:1088.
  10. CDC, Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006.MMWR Recomm Rep. Aug 4 2006;55(RR-11):1-94.

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Last updated: 2018-06-21 20:40