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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
  • 0.025), white blood cell count (21.8 10(9)/L vs 14.9 10(9)/L; P CONCLUSION: The triad of fever, leukocytosis, and diarrhea should alert clinicians to the possibility of TOA formation in patients with PID.[ncbi.nlm.nih.gov]
  • In severe PID , women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC).[web.archive.org]
  • 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]
  • Abstract 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]
Chills
  • In severe PID , women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC).[web.archive.org]
  • 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]
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]
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]
  • Peritonitis, tubo‐ovarian abscess, and severe systemic illness (e.g. fever and malaise) are considered severe forms of PID; the other forms of presentation are considered mild or moderate according to the subjective opinion of the examining doctor or[doi.org]
Rigor
  • Therefore, we individually assessed the following domains of potential bias: source population, method of participant selection, rigor of the exposure measurement, rigor of the outcome measure, control for confounding, and whether the reported data were[dx.doi.org]
  • View Recording Cdc-media View Transcript Cdc-pdf CE Instructions Cdc-pdf Instrucciones para obtener Eduación Continua Cdc-pdf 2015 STD Treatment Guidelines Overview Webinar – June 22, 2015 The STD Treatment Guidelines were developed through a rigorous[cdc.gov]
Abdominal Pain
  • CONCLUSION(S): 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]
  • 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]
  • CASE: 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]
  • 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
  • In severe PID , women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC).[web.archive.org]
  • Other symptoms and signs include nausea or vomiting, urinary symptoms, proctitis and an adnexal mass. Differential diagnosis Other causes of abdominal pain - eg, appendicitis (nausea and vomiting are seen more often than PID), ectopic pregnancy .[patient.info]
  • 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]
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 severe PID , women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC).[web.archive.org]
  • Other symptoms and signs include nausea or vomiting, urinary symptoms, proctitis and an adnexal mass. Differential diagnosis Other causes of abdominal pain - eg, appendicitis (nausea and vomiting are seen more often than PID), ectopic pregnancy .[patient.info]
Acute Abdomen
  • 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]
  • CASE: 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]
  • It is important to keep pelvic infection in the differential diagnosis of virginal patients who present with clinical symptoms of an acute abdomen. Copyright 2014 North American Society for Pediatric and Adolescent Gynecology.[ncbi.nlm.nih.gov]
  • SUMMARY AND CONCLUSION: This case highlights the importance of including PID in the differential diagnosis of noncoital adolescent females presenting with an acute abdomen.[ncbi.nlm.nih.gov]
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]
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]
  • 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]
  • BACKGROUND: 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]
  • View Full Size Test Yourself Sequelae Approximately 25% of women with a single episode of symptomatic PID will experience sequelae, including ectopic pregnancy , infertility , or chronic pelvic pain .[web.archive.org]
Vaginal Discharge
  • Culture of the vaginal discharge revealed the presence of E. coli.[ncbi.nlm.nih.gov]
  • RESULTS: Four variables were independently associated with PID: scattered pain radiation and/or diffuse pain, insidious pain, peritoneal irritation, and abnormal vaginal discharge.[ncbi.nlm.nih.gov]
  • In severe PID , women appear very ill with fever, chills, purulent vaginal discharge, nausea, vomiting, and elevated white blood cell count (WBC).[web.archive.org]
  • Nucleic acid amplification testing from vaginal discharge was positive for C. trachomatis and Trichomonas vaginalis and negative for Neisseria gonorrhoeae.[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]
  • KEYWORDS: Endometritis; Fitz-Hugh–Curtis syndrome; Pelvic inflammatory disease; Salpingitis; Tuboovarian abscess[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]
Dyspareunia
  • Even if they survive, as many as 15% to 20% of these women experience long-term sequelae of PID, such as ectopic pregnancy, tubo-ovarian abscess, infertility, dyspareunia, and chronic pelvic pain.[ncbi.nlm.nih.gov]
  • Women may experience dyspareunia , irregular bleeding, dysuria , or gastrointestinal symptoms, which they may not link to PID, and therefore, may not seek care. C. trachomatis is particularly implicated in subclinical PID.[web.archive.org]
  • Other causes of dyspareunia - eg, endometriosis . Investigations Pregnancy test (pregnant women with PID should be admitted; ectopic pregnancy may be confused with PID).[patient.info]

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.

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