Pelvic Inflammatory Disease

It denotes an infection of the upper genital tract involving the cervix, uterus, fallopian tubes and ovaries. An acute PID is the most common and important complication of sexually transmitted diseases. The true incidence is unknown. It occurs in about 15 to 20% of women in the reproductive age group. 70 % of women in infertility clinics with tubal factor disease have serological evidence of anti-chlamydial antibodies thereby indicating that Chlamydia trachomatis is an important organism in the causation of PID. 50% give no history of previous PID. It is estimated that estimated that one million women are treated for PID each year. An estimated 1 in 8 sexually active adolescent girls will develop PID before age 20. Studies have shown that with laparoscopically diagnosed PID there is an average infertility rate of 20%. Recurrence of infection following one episode of PID is 13 %, after two episodes – 36 % and after three episodes – 75 %. The risk of tubal damage also increases with subsequent infections. The chance of tubal obstruction after first episode is about 10%.This increases to 25 % after a second infection and 40 % after a third infection. Not only is such damage a cause of infertility but it is also associated with a much greater risk of ectopic pregnancy.

Causes

  • Increased sexual activity – Age at first intercourse, frequency and multiple sexual partners.
  • The natural proximity of the vagina to the anus may act as one of the contributors in poor hygiene.
  • Following Pregnancy/Child birth due to easy accessibility of organisms as an ascending infection.
  • Following catheterization of the urinary bladder to facilitate passage of urine especially pre and post operative care.
  • Using non barrier contraceptives (barrier methods protect against PID/STD). Although the usage of oral contraceptive pills does decrease the incidence of PID it does not protect against sexually transmitted diseases like HIV, Hepatitis, syphilis etc.
  • Vaginal douching done regularly may flush the bacteria upwards flaring up an infection.
  • Neisseria Gonorrhoea and C. Trachomatis have a preference for columnar epithelium which is exposed in young individuals but recedes into the cervical canal with increasing age.

Signs and symptoms

  • Abdominal pain either localized or generalized
  • Cervical motion tenderness
  • Adnexal tenderness
  • Fever / Chills – May range from transient to constant or low grade to high
  • Fatigue and lack of appetite
  • Nausea , with or without vomiting
  • Increase in frequency and pain during urination
  • Leucocytosis
  • Vaginal Discharge- with abnormal colour, consistency, or odour
  • Irregular menstrual bleeding or spotting
  • Increased menstrual cramping
  • Increased pain during ovulation
  • Dysparuenia
  • Post coital bleeding

Triad of symptoms

  • Abdominal pain
  • Fever
  • Leucocytosis
  • Fitz – Hugh – Curtis syndrome (1-10%) – Inflammation around the liver & adhesions causing pleuritic pain, tenderness in the right upper quadrant with palpable liver.

Prevention

  • Preventive measures include following safer sexual habits.
  • Certain methods of contraception also can provide significant protection against STD’s. These methods include vaginal spermicidal agents (agents that kill sperm) and barrier methods(condom, diaphragm, cervical cap, sponge), especially when used with spermicides.
  • High risk patients should avoid Intrauterine copper devices.
  • Signs of discharge with odour or bleeding between cycles could mean infection. Early treatment may prevent the development of PID.
  • Maintaining hygiene near the perineal area (region of the vagina and anus) also reduces chances of infection.
http://www.cdc.gov/std/PID/STDFact-PID.htm