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

• Adnexal Tumors

• Appendicitis

  • Cervicitis

  • Cholecystitis

  • Diverticulitis

• Ectopic Pregnancy

• Endometriosis

  • Ovarian Cyst

  • Ovarian torsion

  • Spontaneous Abortion

  • Urinary Tract Infection

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