Family doctor

What is it?

The term pelvic inflammatory disease or PID is used to describe an upper genital tract infection, giving no indication of the site or severity. The term should not be used to describe the lower genital tract infections, vulvitis, vaginitis, and cervicitis.

Usually the disease is caused by organisms originating in the lower genital tract. Often these organisms are introduced by gynaecological procedures such as:

• Insertion of a intrauterine contraceptive device (IUD)
• Dilation and curettage (following a miscarriage)
• Laproscopy and dye testing
• Termination of pregnancy

In a non-medical cause, sperm are thought to attach to the bacteria and facilitate their migration upwards.

Once the bacteria have ascended the cervix into the uterus, it starts a process causing a uterine infection or an endometritis. Thereafter, it enters the fallopian tube and causes inflammation there (salpingitis). It leaks through the tubes into the pelvis causing sticky adhesions between the pelvic organs. This often results in permanent damage to the fallopian tubes and abscess formation in the pelvis.

It is possible that in the stage prior to tubal damage if promptand appropriate treatment is given then the tubes will be spared.

The causative organisms most commonly blamed are:

• Chlamydia trachomatis
• Neisseria gonorrhoea
• Mycoplasma hominis
• Gardnerella vaginalis

What are the symptoms?

PID has a wide spectrum of clinical features ranging from no symptoms at all to a life threatening disease.

The laparoscope is the gold standard instrument used in the diagnosis of PID.

Women often present with vague pelvic pain, some urinary discomfort, and an offensive vaginal discharge.

They may or may not recall a contact with an infected male partner.

In the management of this condition, the obtaining of adequate samples of sexually transmitted bacteria from the lower genital tract is mandatory. Appropriate partner screening is equally important.

Blood tests of white cell count measurements and ESR are also helpful.

The laparoscope will detect PID in most cases due to:

• Red, inflammed pelvic organs
• Presence of pelvic pus
• Presence of pelvic abscesses

Ultrasound may help in detecting collections of pus.

What can be done to help?

In all but the mildest cases hospital admission should occur, the appropriate tests performed, and antibiotics given in the correct dose and for the correct duration of time.

The long-term consequences of PID are:

• Infertility
• Chronic pelvic pain
• Chronic pain with sex (dyspareunia)
• Recurrent episodes of acute pelvic infections
• Chronic ill health

Conclusion

PID needs to be positively and accurately diagnosed . The organisms which caused the condition need to be defined, and rapid treatment given in order to prevent chronic ill health, infertility, and chronic pelvic pain.