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Pelvic Inflammatory Disease (PID)

PID can be defined as infection of the upper genital tract involving the cervix (mouth of the uterus), uterus, fallopian tubes, parametria (sides of the uterus and ovaries). 

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Occurrence

The true incidence of PID is unknown. It occurs in about 15-20% of the general population. It is estimated that one million women are treated for PID each year of which between 100- 200 of every 100,000 women have PID. Roughly 1 in 8 sexually active adolescent girls will develop PID before the age of 20.

Etiology

  • The commonest causes of PID is infection due to Neisseria gonorrhoeae
  • This is a sexually transmitted disease (STD).
  • The next common cause is ascending polymicrobial infection by aerobic and anaerobic micro-organisms.
  • Naturally occurring infection in sexually active female of reproductive age (85%).
  • Infection following procedures like endometrial biopsy, uterine curettage and insertion of Intra uterine contraceptive device (IUCD). These procedures break the cervical mucus barrier that protects the genital organ from infection.
  • Last but not the least is the puerperal infection ie PID following delivery.

Infective Organisms commonly belong to Gram negative and gram positive bacilli. For example E.Coli, Neisseria gonorrhoeae (a), Chlamydia trachomatis, Klebsiella, pseudomonas, Staphylococcus etc.,

The other non bacterial pathogens are Mycoplasma hominis, Ureaplasma Urealyticum, Actinomyces israelii, Mycobacterium tuberculosis and virus like Herpes simplex (HV-2)

The Main Predisposing Factors

  • Increased sexual activity like first intercourse at an early age, sexual frequency and contact with multiple partners.
  • Proximity of the vagina to the anus and short length of vagina(4 cm) facilitates easy ascending infection.
  • Pregnancy and child birth are added trauma to the female genital tract
  • Frequent catheterization adds to infection Regular douching may flush bacteria up.

Signs

A general examination may

  • Reveal enlarged lymph nodes in the groin area.
  • Abdominal tenderness.
  • Pelvic examination may reveal cervical discharge, cervical tenderness, a friable cervix (one that bleeds easily), uterine tenderness, or adnexal (ovarian) tenderness

Symptoms

  • PID, particularly when caused by chlamydial infection, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs
  • Vaginal discharge – with abnormal colour, consistency, or odour
  • Irregular menstrual bleeding or spotting
  • Increased menstrual cramping
  • Increased pain during ovulation
  • painful sexual intercourse,
  • Bleeding after intercourse
  • Fever with chills – Low grade to high
  • Abdominal pain either localized or generalized
  • Low back pain
  • Fatigue and Lack of appetite
  • Nausea , with or without vomiting
  • Frequent and painful urination

Signs

  • White Blood Cell count (WBC count)
  • Erythrocyte Sedimentation Rate(ESR)
  • A wet prep or wet mount microscopic examination for the infective organism
  • An endocervical culture for gonorrhoea , Chlamydia and other organisms
  • A laparoscopy may be required

Untreated PID can give rise to

  1. Systemic illness
  2. Frequent fever & rigors
  3. Septicaemia
  4. Long term effects like
  • Dysmenorrhoea and/or dyspareunia
  • Bilateral adnexal tenderness
  • Tubo-ovarian mass