Pelvic inflammatory disease (PID) is an inflammatory condition of pelvic cavity that may begin with vaginal infections such as cervicitis and may involve internal organs like uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum or pelvic vascular systems. An acute, sub acute, recurrent, or chronic and localized or widespread infection is usually caused by bacteria but may be attributed by other organisms like virus, parasites, or fungal. The most likely causing organisms are gonorrhoeal and chlamydial. This condition can result in the fallopian tubes becoming narrowed and scarred, which probably increases the risk for ectopic pregnancy ( fertilization occurs in tubes rather than uterus), infertility, recurrent pelvic pain, tubal ovarian abscess, and recurring diseases. Rupture of tubal-ovarian abscess has a 5% to 10% mortality rate and usually demands a complete hysterectomy (removal of uterus). PID is a common gynaecological problems for visiting hospital and seeking consultation.
The exact physiology of PID has not been known,, however it is presumed that causing organisms usually enter the body through the vagina, pass through cervical canal, conolozing the endocervix further moving upward into the uterus. Under various favourable conditions, the organism may proceed to one or both fallopian tubes, ovaries and into the pelvis finally. During pregnancy, the increase blood supply required by the placenta provides more pathways for infection. These postpartum and post abortion infections tend to be unilateral. Infections can cause perihepatic inflammation when the organisms invade the peritoneum.
In bacterial infections that occur after the child birth or abortion, pathogens are disseminated directly through the tissues that support the uterus by way of lymphatics and blood vessels. In gonorrhoeal infections, the gonococci pass through the cervical canal and into the uterus, where the environment is favourable for bacterial growth, especially during menstruation allows them to multiply rapidly and spread to the fallopian tubes and pelvis which is usually bilateral (in both). In rare, organisms (tuberculosis ) gain access to the reproductive organs through the way of the blood stream from the lungs. One of the most common causes of salpingitis (inflammation of the fallopian tube) is chlamydia, Mostly accompanied by gonorrhoea.
Pelvic infection is mostly caused by sexual transmission but can also occur from invasive procedures like pelvic examination with contaminated hands and devices, endometrial biopsies, surgical abortion, hysteroscopy or insertion of an intrauterine device. Bacterial vaginosis, a vaginal infection may predispose women to pelvic infection.
Risk factors include early age at first intercourse, multiple sexual partners, frequent intercourse, intercourse without condoms, sex with a partner with STIs (Sexually transmitted infections) and a history of previous pelvic infection. Other factors include improper hygiene in cleaning genital area and use of sanitary pads for prolonged period without changing.
Signs and symptoms
Symptoms of pelvic infection usually begins with
- Vaginal discharge
- Pain in lower abdomen pelvic
- Tenderness after menstruation
- Signs of infections include fever, general malaise, anorexia, nausea and vomiting, headache.
- On pelvic examination, intense tenderness may he noted on palpation of the uterus or movement of the cervix (cervical motion tenderness)
Symptoms may be acute and chronic, severe or low grade and subtle.
- Pelvic or generalised peritonitis, abscesses, strictures and fallopian tube obstruction may develop gradually.
- Obstruction further may cause ectopic pregnancy in future if a fertilized egg cannot pass a tubal stricture or scar tissue may occlude the tubes resulting in sterility.
- In late stages, ectopic pregnancy can be fatal of tubes perforate or rupture cause heavy internal bleeding leading to hypovolemic shock if not managed timely the one can have death.
- Adhesions are common and often result in chronic pelvic pain which may later on require removal of uterus, fallopian tubes and ovaries.
- Other complications include bacteraemia with septic shock and thrombophlebitis with possible embolization.
On visit to hospital, the gynaecologist may ask you about your menstrual cycle( normal or abnormal, frequency, painful), sexual activity and protection during sexual contact, use of contraceptive, query for genital infection, and may ask you about the health hygiene along with pelvic examination, vaginal swab culture, if needed haematological biochemistry studies to identify the infection causing agent which allows gynaecologist to diagnose the disease. Diagnostic laparoscopy or hysteroscopy may be needed to identify underlying anatomical anomalies.
- Broad-spectrum antibiotic therapy is prescribed , usually a combination of ceftriaxone , azithromycin or doxycycline.
- Women with mild infections may be treated as outpatients where hospitalization is not necessary.
- Intensive therapy include bed rest, intravenous (IV) fluids and IV antibiotic therapy.
- During hospitalization, careful monitoring of vital signs, balance of fluid, regular haematological and biochemistry studies to identify the prognosis.
- Treatment to sexual partner is necessary in order to prevent and treat pelvic infections.
- Awareness on safe sex ( use of condoms, avoid multiple sex partners)
- Emphasis on women’s health education and awareness programmes in developing areas.
- Health teaching on hygiene ( use of clean cotton undergarments, use of cotton sanitary pads than jelly infused sanitary pads and tampons)
- Proper perineal care involves wiping from front to back after defecation or urination.
- Hand hygiene
- For health care provider use of sterilised devices to examine pelvis to avoid infection from health care provider.