A Family Doctor's Tale - PELVIC INFLAMMATORY DISEASE

DOC I HAVE PELVIC INFLAMMATORY DISEASE

Pelvic inflammatory disease (PID) is a general term used to describe inflammatory disorders of the upper female genital tract, such as infection of the uterus, fallopian tubes, ovaries and tissues around the reproductive organs.


It is the result of infection from some sexually transmitted diseases especially chlamydia and gonorrhea. The fallopian tubes and tissues in and near the uterus and ovaries are the most frequent organs damaged.

Sexually active women in their childbearing years are most likely to get PID. Women under age 25 are more likely to develop PID than those older than 25. The cervix of young women is not fully matured, and therefore more prone to be infected by STD.

Vaginal douching in women changes the vaginal bacteria flora in harmful ways, and can also force bacteria into the upper reproductive organs from the vagina.

Women with an intrauterine device (IUD) inserted has an increased risk of PID compared with women using other contraceptives or no contraceptive at all.


Symptoms of PID can vary widely.
Women whose PID is caused by chlamydial infection may have mild symptoms or no symptoms at all even as serious damage is being done to her reproductive organs. Most cases of PID are not detected about two thirds of the time.

Common symptoms of PID are
1.lower abdominal pain
2.fever,
3.unusual vaginal discharge with a foul odor,
4.painful intercourse,
5.painful urination,
6.irregular menstrual bleeding, and
7.pain in the right upper abdomen (rare).


Prompt and appropriate treatment can help prevent complications of PID. Without treatment, PID can cause
1. permanent damage to the female reproductive organs. Infection-causing bacteria can invade the fallopian tubes, damaging the lining of the tubes causing blockage of the fallopian tubes and preventing sperm from fertilising an egg.

2.Infertility also occur when the fallopian tubes are partially blocked or even slightly damaged as therm may find it difficult to reach the egg.

3.ectopic pregnancy may occur when the fertilized egg remains in the partially blocked fallopian tube and begins to grow. As it grows, an ectopic pregnancy can cause rupture of the fallopian tube resulting  abdominal pain, internal bleeding, and death.

4.chronic pelvic pain that lasts for months or even years due to the inflammation, damage to the pelvic organs, and contraction of the scarred tissues.

5.endometrosis are blood clots in the pelvic region which occurs due to inflammation of the pelvis and can also cause pain during menses.


Because the symptoms are often subtle and mild, most cases of PID go undetected.

Diagnosis is usually based on clinical findings:
1.lower abdominal pain
2.abnormal vaginal or cervical discharge,r
3.evidence of gonorrheal or chlamydial infection.
4. pelvic ultrasound is a helpful procedure for diagnosing PID. An ultrasound can view the pelvic area to see whether the fallopian tubes are enlarged or whether an abscess is present.
5.laparoscopy is a minor surgical procedure in which a thin, flexible tube with a lighted end (laparoscope) is inserted through a small incision in the lower abdomen. This procedure enables the doctor to view the internal pelvic organs and to take specimens for laboratory studies, if needed.


PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider two to three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman's sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; or (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess). If symptoms continue or if an abscess does not go away, surgery may be needed. Complications of PID, such as chronic pelvic pain and scarring are difficult to treat, but sometimes they improve with surgery.


STD (mainly untreated Chlamydia or gonorrhea) is the main preventable cause of PID. Women can protect themselves from PID by taking action to prevent STDs or by getting early treatment if they do get an STD.

The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Latex male condoms, when used consistently and correctly, can reduce the risk of transmission of chlamydia and gonorrhea.