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Pelvic Inflammatory Disease

Definition
  • Iinfectious and inflammatory disorder of the upper female reproductive tract
Risk Factors
  • Multiple sexual partners
  • History of prior STIs
  • History of sexual abuse
  • Frequent vaginal douching
  • Younger age
  • Iatrogenic
    • Breaking cervical barrier
Differential diagnosis
Epidemiology
  • From 1995-2001, 769,859 cases of PID were reported in the United States
Aetiology
  • Vaginal or cervical infection
    • Commonly Neisseria gonorrhoeae and Chlamydia trachomatis
  • Direct ascent of micro-organisms from the vagina and cervix
    • Efficacy of mucus plug?
Clinical features
  • Lower abdominal pain
    • Dull, aching or crampy, bilateral, and constant
    • Begins a few days after the onset of the last menstrual period and tends to be accentuated by motion, exercise, or coitus.
    • Pain may be exacerbated by movement or sexual activity (dyspareunia).
    • Pain from PID usually lasts less than 7 days
  • Unanticipated vaginal bleeding, often postcoital
  • Temperature higher than 38.3°C (101°F)
  • Abnormal cervical or vaginal mucopurulent discharge
  • Presence of white blood cells (WBCs) on saline microscopy of vaginal secretions
  • Elevated erythrocyte sedimentation rate
  • Elevated C-reactive protein level
  • Laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis
Pathophysiology

Investigations

Management

a) conservative

b) medical

c) surgical

Prognosis
  • Tubo-ovarian abscess
  • Pelvic peritonitis and Fitz-Hugh-Curtis syndrome (perihepatitis)
  • Long-term sequelae such as chronic pelvic pain and tubal infertility
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