Pelvic Inflammatory

– Infection of the fallopian tubes, which may extend to the ovaries, pelvic peritoneum, or uterine connective tissue.

Causes and Incidence

Pelvic inflammatory disease (PID) is caused by a pathogen, the most common of which are Chlamydia trachomatis and Neisseria gonorrhoeae. The pathogen is usually transmitted during intercourse but may also be introduced during abortion and childbirth. Women with intrauterine devices (IUDs) are at greater risk, as are sexually active women with multiple partners. Adolescent and young adult women are most often affected.

Disease Process

The infection typically begins intravaginally and spreads upward through the entire genital tract to the fallopian tubes. The infection, which may be unilateral or bilateral, produces a profuse exudate in the tubes that leads to agglutination of the mucosal folds, adhesions, and tubal occlusion. Peritonitis from spreading exudate is common, and the ovaries may also be invaded.

Symptoms

PID may be either acute or chronic.

Acute
Onset typically occurs after onset of menses; progressive lower abdominal pain with guarding and rebound tenderness; fever, copious purulent cervical discharge; nausea and vomiting; malaise; urinary urgency and frequency; vaginal itching and maceration

Chronic
Chronic pain; menstrual irregularities; recurrence and exacerbation of acute symptoms

Potential Complications

Common complications include generalized peritonitis, sterility, and ectopic pregnancy.

Diagnostic Tests

Clinical manifestations coupled with elevated WBCs and erythrocyte sedimentation rate plus a positive culture of secretions are diagnostic. Upon pelvic examination, moving of the cervix causes severe pain and rebound tenderness is present in abdomen. Laparoscopy may be used as a differential diagnostic tool.

Treatments

Surgery
Salpingolysis to remove adhesions; salpingostomy to reopen blocked fallopian tube; salpingo-oophorectomy for ruptured tube or ectopic pregnancy; in vitro fertilization for sterility.

Drugs
Antiinfective drugs, usually in combinations to control and alleviate infection.

General
Bed rest in semi-Fowler’s position; adequate hydration; removal of IUDs; tracking and treatment of sexual partners; sexual abstinence and avoidance of tampons and douching during treatment; instruction about sexually transmitted diseases and safer sexual practices.