Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus and upper genital tract. Many women who develop pelvic inflammatory disease either experience no signs or symptoms or don't seek treatment. Pelvic inflammatory disease may be detected only later when you have trouble getting pregnant or if you develop chronic pelvic pain.
Symptoms in PID range from subclinical (asymptomatic) to severe. If there are symptoms, then fever, cervical motion tenderness, lower abdominal pain, new or different discharge, painful intercourse, or irregular menstrual bleeding may be noted. It is important to note that even asymptomatic PID can and does cause serious harm. Laparoscopic identification is helpful in diagnosing tubal disease, 65–90% positive predictive value in patients with presumed PID. Regular Sexually Transmitted Infection (STI) testing is important for prevention. Treatment is usually started empirically because of the serious complications that may result from delayed treatment. Definitive criteria include: histopathologic evidence of endometritis, thickened filled fallopian tubes, or laparoscopic findings. Gram-stain/smear becomes important in identification of rare and possibly more serious organisms.
A woman can get PID if bacteria (germs) move up from her vagina and infect her pelvic organs. Many different types of bacteria can cause PID. But, most cases of PID are caused by bacteria that cause 2 common sexually transmitted infections (STIs) — gonorrhea and chlamydia. It can take from a few days to a few months for an infection to travel up from the vagina to the pelvic organs.
You can get PID without having an STI. Normal bacteria found in the vagina and on the cervix can sometimes cause PID. No one is sure why this happens. You can get pelvic inflammatory disease without having an STI. Normal bacteria found in the vagina and on the cervix can sometimes cause pelvic inflammatory disease. No one is sure why this happens.
# Pelvic inflammatory disease (PID) is an infection of a woman's pelvic organs including the uterus (womb), Fallopian tubes (tubes), ovaries, and cervix.
# Pelvic inflammatory disease develops as the result of spread of a sexually transmitted disease.
# Most cases of pelvic inflammatory disease are caused by gonorrhea and/or Chlamydia
# Young, sexually active women with multiple sex partners are at greatest risk for pelvic inflammatory disease .
# Pelvic inflammatory disease many not produce any symptoms. In other cases it can cause fever, abdominal or pelvic pain, vaginal discharge, painful urination, or painful sexual intercourse.
# Pelvic inflammatory disease is treated with antibiotics.
# Complications of untreated pelvic inflammatory disease can include scarring of the pelvic organs and infertility.
Complications
PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, infertility, ectopic pregnancy (the leading cause of pregnancy-related deaths in adult females), and other dangerous complications of pregnancy. Occasionally, the infection can spread to in the peritoneum causing inflammation and the formation of scar tissue on the external surface of the liver (Fitz-Hugh-Curtis syndrome). Multiple infections and infections that are treated later are more likely to result in complications.
Fertility may be restored in women affected by PID. Traditionally tuboplastic surgery was the main approach to correct tubal obstruction or adhesion formation, however success rates tended to be very limited. In vitro fertilization (IVF) has been used to bypass tubal problems and has become the main treatment for patients who want to become pregnant.
Treatment
Treatment depends on the cause and generally involves use of antibiotic therapy. If the patient has not improved within two to three days after beginning treatment with the antibiotics, they should return to the hospital for further treatment. Drugs should also be given orally and/or intravenously to the patient while in the hospital to begin treatment immediately, and to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if the patient has Tubo-ovarian abscesses; is very ill, immunodeficient, pregnant, or incompetent; or because a life-threatening condition cannot be ruled out. Treating partners for STIs is a very important part of treatment and prevention. Anyone with PID and partners of patients with PID since six months prior to diagnosis should be treated to prevent reinfection. Psychotherapy is highly recommended to women diagnosed with PID as the fear of redeveloping the disease after being cured may exist. It is important for a patient to communicate any issues and/or uncertainties they may have to a doctor, especially a specialist such as a gynecologist, and in doing so, to seek follow-up care.
A systematic review of the literature related to PID treatment was performed prior to the 2006 CDC sexually transmitted infections treatment guidelines. Strong evidence suggests that neither site nor route of antibiotic administration affects the short or long-term major outcome of women with mild or moderate disease. Data on women with severe disease was inadequate to influence the results of the study.
Prevention
# Risk reduction against sexually transmitted infections through barrier methods such as condoms; see human sexual behavior for other listings.
# Going to the doctor immediately if symptoms of PID, sexually transmitted infections appear, or after learning that a current or former sex partner has, or might have had a sexually transmitted infection.
# Getting regular gynecological (pelvic) exams with STI testing to screen for symptomless PID.
# Discussing sexual history with a trusted physician in order to get properly screened for sexually transmitted diseases.
# Regularly scheduling STI testing with a physician and discussing which tests will be performed that session.
# Getting a STI history from your current partner and insisting they be tested and treated before intercourse.
# Treating partners to prevent reinfection or spreading the infection to other people.
# Diligence in avoiding vaginal activity, particularly intercourse, after the end of a pregnancy (delivery, miscarriage, or abortion) or certain gynecological procedures, to ensure that the cervix closes.
See also
- Salpingitis, any inflammation of the fallopian tubes
- Tubo-ovarian abscess an abscess of the fallopian tube and ovary
- Endometritis
- Pelvic peritonitis
- Dalkon Shield — withdrawn from the market in 1975 for PID risk
- Bacterial Vaginosis
References
^ a b c Loscalzo, Joseph; Andreoli, Thomas E.; Cecil, Russell L.; Carpenter, Charles A.; Griggs, Robert C. (2001). Cecil essentials of medicine. Philadelphia: W.B. Saunders. ISBN 0-7216-8179-4. OCLC 43051599.
^ "STD Facts — Pelvic inflammatory disease (PID)". Retrieved 2007-11-23.
^ Sutton MY, Sternberg M, Zaidi A, St Louis ME, Markowitz LE (December 2005). "Trends in pelvic inflammatory disease hospital discharges and ambulatory visits, United States, 1985–2001". Sex Transm Dis 32 (12): 778–84. doi:10.1097/01.olq.0000175375.60973.cb. PMID 16314776.
^ a b c Lauren Nathan; DeCherney, Alan H.; Pernoll, Martin L. (2003). Current obstetric & gynecologic diagnosis & treatment. New York: Lange Medical Books/McGraw-Hill. ISBN 0-8385-1401-4. OCLC 150148652.
^ Tuboovarian complex by Emily C. Wasco and Gillian Lieberman MD. Beth Israel Deaconess Medical Center. October 17, 2003
^ Blenning CE, Muench J, Judkins DZ, Roberts KT (2007). "Clinical inquiries. Which tests are most useful for diagnosing PID?". J Fam Pract 56 (3): 216–20. PMID 17343812.
^ Walker CK, Wiesenfeld HC (2007). "Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines". Clin. Infect. Dis. 44 (Suppl 3): S111–22. doi:10.1086/511424. PMID 17342664.
^ Pelvic Inflammatory Disease~treatment at eMedicine
^ Smith KJ, Cook RL, Roberts MS (2007). "Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: influence on the cost-effectiveness of different screening intervals". Value Health 10 (5): 358–66. doi:10.1111/j.1524-4733.2007.00189.x. PMID 17888100.
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