Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) refers to inflammatory damage and destruction of pelvic reproductive organs of the females (such as uterus, fallopian tubes and the ovaries). The women who have a history of sexually transmitted infections are at highest risk. If not treated in time, PID can lead to formation of strictures (obliteration or obstruction of genital tubes) and may lead to infertility.

Epidemiology & Statistics

PID mostly affect women in their teens. In the US, approximately 1 million females are diagnosed with PID each year. On an average, about 100,000 of these females develop infertility and other related complications. In addition, a large number of ectopic pregnancies also results in the US strictly due to PID.

What Is The Pathophysiology Of Pelvic Inflammatory Disease?

Two Sexually Transmitted Infections (STIs), namely Gonorrhea and Chlamydia accounts for the majority of cases of PID. In most cases, infection and inflammation process starts from the vagina and cervix. If no treatment is sought, the cervix loses its protective function and allows the bacteria to ascend and infect the internal reproductive organs. According to latest statistics reported by Centers for Disease Control and Prevention (1), investigators suggested that each year more than 1.5 million cases of Chlamydia are reported in the US making it the most frequently reported sexually transmitted infection. Gonorrhea is the second most common infection, with each year more than 301,174 reported cases in reproductive-aged women (15-45 years).

Besides sexually transmitted infections, other causes of PID include; complicated childbirths that are performed in unhygienic conditions, pelvic surgeries and unclean (septic) abortions.

Risk Factors And Transmission

As PID is mainly caused by sexually transmitted infections, following factors can make a woman more susceptible to develop PID:

• Multiple sexual partners
• Having a partner who has multiple sexual partners
• Being exposed to sexually transmitted infections
• Young, sexually active girls are more prone to get infected
• Intra-Uterine Device used as a method of contraception has also been implicated in some cases due to inflammatory response
• Frequent douching

Clinical Presentation & Symptomatology

PID can be asymptomatic or present with mild, non-specific symptoms. If a woman has any of the predisposing factors mentioned above, she should consult a gynecologist for screening and monitoring of the disease.

Following symptoms are frequently reported in patients with PID:

• Vague lower abdominal pain
• Yellowish/greenish colored or foul smelling discharge from the vagina
• Painful micturition (urination)
• Low grade fever, nausea, vomiting
• Inter-menstrual bleeding (occurring in between monthly cycles)
• Pain or bleeding during sex

Diagnosis & Investigation

Women under 25 years of age, who are at higher risk of getting an infection, should visit a doctor on an annual basis. In case of unprotected sex, report to the doctor and follow the advice.

There is no specific test to diagnose PID. Following procedures or tests can be undertaken:

• A thorough examination of the vagina and internal pelvis, visually as well as with the help of instruments.
• Analysis of the vaginal discharge, in which a sample is taken from the vagina and cervix with a cotton swab stick, and sent to the microbiology section of the laboratory to identify the pathogen
• Urine Test

Further testing may be required under special circumstances, if necessary:

• Ultrasound of the pelvic organs
• Endometrial biopsy in which a small piece of uterine lining is obtained for further tests
• Laparoscopy, in which a small tube is passed through the abdomen to visualize the internal pelvic organs

Treatment

Medical:

After diagnosis, treatment should be started immediately to prevent complications. It includes the use of antibiotics. The treatment should be completed even after the symptoms have been resolved. The sexual partner should also get a full course of treatment even if he doesn’t show any symptoms.

Surgical:

In case, medical treatment doesn’t work and an abscess (a localized collection of pus) has been formed, surgery may be necessary to remove it, either through laparoscopy or laparotomy.

Preventive measures

Following precautions should be taken to prevent PID:

• Sticking to one trusted sexual partner.
• Using condom if you are in polygamous relationship.
• Timely visit to the healthcare worker if one has contracted the sexually transmitted infection

• Complications:
• Chronic pain in the abdomen or pelvic region
• Ectopic Pregnancy in which the fertilized egg is implanted in the fallopian tube (or any other part of abdominal cavity). If the ectopic pregnancy ruptures, affected person will develop life-threatening bleeding, life-long infertility and relationship issues.
• Female infertility is a common complication of PID due to obliteration or destruction of fallopian tubes.

References

1. Rekart, M. L., Gilbert, M., Meza, R., Kim, P. H., Chang, M., Money, D. M., & Brunham, R. C. (2013). Chlamydia public health programs and the epidemiology of pelvic inflammatory disease and ectopic pregnancy. Journal of Infectious Diseases, 207(1), 30-38.

2. Gottlieb, S. L., Xu, F., & Brunham, R. C. (2013). Screening and treating Chlamydia trachomatis genital infection to prevent pelvic inflammatory disease: interpretation of findings from randomized controlled trials. Sexually transmitted diseases, 40(2), 97-102.