Pelvic Inflammatory Disease (PID) - Causes, Signs & Symptoms, Diagnosis, And Treatment
Pelvic Inflammatory Disease Overview
Definition and Causative Organisms
- Pelvic inflammatory disease (PID) is an infectious and inflammatory condition affecting the upper female genital tract, including the uterus, fallopian tubes, and adjacent pelvic structures.
- The most common causative organism of PID is Chlamydia trachomatis, with other contributors including Neisseria gonorrhoeae, Gardnerella vaginosis, Haemophilus influenzae, and anaerobes such as Peptococcus and Bacteroides species.
Risk Factors
- Key risk factors for developing PID include:
- Having multiple sexual partners.
- A history of sexually transmitted infections (STIs).
- Engaging in sexual intercourse at a younger age.
- Use of intrauterine devices (IUDs).
- Gynecological procedures like hysteroscopy, endometrial biopsy, and curettage.
Pathophysiology
- PID typically progresses in two stages:
- Acquisition of a vaginal or cervical infection, often from STIs.
- Ascension of microorganisms from the vagina or cervix to the upper genital tract facilitated by various mechanisms:
- Decreased efficacy of the cervical mucosal barrier due to inflammation.
- Disruption of normal flora from antibiotic treatment.
- Opening of the cervix during menstruation or sexual intercourse.
Symptoms and Complications
- Symptoms vary based on disease severity; some may be minimally symptomatic while others present with severe symptoms such as:
- Fever, nausea, vomiting, severe abdominal/pelvic pain.
- Abnormal vaginal discharge occurs in about 75% of cases; around 40% may experience unexpected vaginal bleeding.
- Complications can include chronic pelvic pain, infertility, and ectopic pregnancy. Approximately one-third of women may have abnormal uterine bleeding.
Diagnosis and Treatment
- Laparoscopy is considered the criterion standard for diagnosing PID; additional tests include:
- Pregnancy tests to rule out ectopic pregnancy.
- Urinalysis to exclude urinary tract infections.
- Vaginal/cervical swabs for bacterial culture.
- Specific tests for syphilis, hepatitis, and HIV infections are also recommended. An ultrasound scan can help exclude other pathologies involving the genital tract.
- Treatment focuses on alleviating acute symptoms, eradicating current infections, and minimizing long-term risks; antibiotics alone are successful in approximately 33% to 75% of cases if surgery is not required. Conservation of reproductive health is emphasized during treatment planning.