Pelvic Inflammatory Disease (PID)
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Pelvic Inflammatory Disease

Obstetrics and GynaecologyReproductive Medicine

Pelvic Inflammatory Disease (PID) is one of the common gynaecological conditions, referring to the condition where there is an infection and inflammation in the pelvic organs of the female reproductive system, including the uterus, fallopian tubes, and ovaries. As PID is often caused by bacterial infections, especially those transmitted through sexual contact, it is more prevalent among young women aged 15 to 44.

Symptoms

The symptoms of pelvic inflammatory disease (PID) can vary in severity but generally include the following common symptoms:

  • Persistent Lower Abdominal Pain or Back Pain: The most common symptom, constant pain, usually originates from the pelvic area or lower back, ranging from mild discomfort to severe pain.
  • Abnormal Discharge: This includes unusual changes in the colour, texture, and odour of vaginal discharge, often accompanied by an increase in discharge.
  • Vaginal Bleeding: Abnormal bleeding may occur outside of the menstrual cycle.
  • Fever: Fever may occur as the body's immune response to infection.
  • Difficulty Urinating or Frequent Urination: Pain or an increased frequency may be present during urination.
  • Painful Intercourse: Pain may be experienced during sexual activity.
  • Irregular Menstruation: Pelvic inflammatory disease may affect the normal menstrual cycle.
  • Lower Back Pain: Discomfort or pain may be felt in the lower back or pelvic area.

If symptoms suggest pelvic inflammatory disease, seeking medical advice and treatment as early as possible is recommended.

Causes and Factors

The cause and risk factors of pelvic inflammatory disease (PID) are typically associated with infections, primarily when bacteria, viruses, or other microorganisms enter the female reproductive system, leading to infection and inflammation of the pelvic organs. Here are the causes and risk factors:

Causes

  • Sexually Transmitted Infections (STIs): One of the primary causes of PID is sexually transmitted infections, especially gonorrhoea and chlamydia. If left untreated, these infections can spread in the reproductive tract to the uterus, fallopian tubes, and ovaries.
  • Childbirth, Abortion, and Gynaecological Surgery: Childbirth, abortion, or other gynaecological surgeries may introduce bacteria into the reproductive organs, increasing the risk of infection.
  • Retrograde Infection: Retrograde infection occurs when a backward flow of cervical mucus and uterine content flows, allowing bacteria to enter the fallopian tubes, leading to PID.
  • Intrauterine Device (IUD): Intrauterine devices, especially during an infection, may increase the risk of infection.
  • Unprotected Sexual Activity: Engaging in unprotected sexual activity, particularly with multiple sexual partners, increases the risk of acquiring sexually transmitted pathogens.

Risk Factors

  • Age: Young women, especially those between 15 and 42, are more susceptible to PID.
  • Age at Onset of Sexual Activity: Women who initiate sexual activity at an early age may face a higher risk.
  • Multiple Sexual Partners: Having multiple sexual partners increases the risk of acquiring sexually transmitted infections.
  • History of STIs: Women with a history of previous sexually transmitted infections, especially chlamydia or gonorrhoea, may be more prone to PID.
  • Use of IUD: Women using intrauterine devices, especially during infection, may face an increased risk.
  • Uterine Procedures: Women who have undergone uterine procedures, such as abortion or endometrial scraping, may be at risk.
  • History of Previous PID: Women with a history of previous PID, especially if left untreated, may be more prone to recurrent infections.

Diagnosis

The diagnosis of Pelvic Inflammatory Disease typically involves the comprehensive use of various methods to determine the presence of infection and inflammation. Here are some common diagnostic approaches:

  • Clinical Examination: Doctors may perform a pelvic exam to inspect the uterus, ovaries, fallopian tubes, and adjacent areas for signs of swelling, tenderness, or other abnormalities.
  • Medical History Inquiry: Physicians will inquire about the patient's sexual history, history of sexually transmitted infections (STIs), gynaecological surgeries, etc., helping identify potential sources of infection.
  • Laboratory Tests: This includes blood tests to check for inflammatory markers like white blood cell count and C-reactive protein and urine tests to rule out other possible infections.
  • Ultrasound Examination: Ultrasound imaging can be used to observe the condition of pelvic organs, confirming the presence of swelling, abscesses, or other abnormalities.
  • Hysterosalpingography (HSG): This test confirms whether the fallopian tubes are clear. It involves injecting a contrast agent into the uterus and taking X-ray images.
  • Laparoscopic: Laparoscopic is a diagnostic procedure that involves inserting a fibre-optic camera through small incisions in the abdominal wall to observe the organs within the abdominal cavity, aiding in identifying inflammation and tissue changes.
  • Pathogen Detection: Doctors may conduct secretion tests to identify specific pathogens causing the infection, such as gonorrhoea or chlamydia.

Early diagnosis and treatment of PID are crucial for preventing potential complications like infertility and chronic pelvic pain. Therefore, seeking medical attention promptly is essential for suspected symptoms of infection.

Treatments

Pelvic Inflammatory Disease is typically treated through medication to eliminate the infection and alleviate associated symptoms.

  • Antibiotic therapy: Antibiotic infections often cause PID, so antibiotics are the primary treatment. Broad-spectrum antibiotics may be prescribed to cover a range of bacteria responsible for the infection, such as gonorrhoea, chlamydia, and others. In some cases, hospitalization and intravenous antibiotic administration may be necessary.
  • Pain relievers and anti-inflammatory drugs: Doctors may recommend using pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs), to alleviate lower abdominal pain or other discomfort. Patients should use these medications as directed by their doctor.
  • Rest and recovery: During treatment, patients need adequate rest and should avoid sexual activity to promote the body's recovery. Additionally, patients should follow their doctor's advice and complete the entire course of antibiotics, even if symptoms improve.
  • Testing and treating the source of infection: If PID is transmitted through sexual contact, the patient's sexual partners should also undergo testing and treatment to prevent recurrent infections.
  • Regular follow-up visits: Throughout the treatment process, doctors may request regular follow-up visits to ensure that the infection is being appropriately treated. Regular check-ups can also monitor the progress of the condition and secure recovery.
  • Surgery: In some instances, especially when PID leads to complications such as pelvic abscess or peritonitis, surgery may be necessary. The purpose of surgery is to drain abscesses, repair damaged tissues, or address other issues that may be causing symptoms.

FAQ

Pelvic Inflammatory Disease is typically caused by infections, with the most common source being sexually transmitted infections (STIs). However, PID can also be caused by non-STIs, such as intestinal bacteria or other microbes entering the reproductive system, leading to infection and inflammation.
Yes, PID can increase the risk of infertility or difficulty getting pregnant. PID can lead to infections and inflammation in the fallopian tubes, potentially resulting in tubal blockages. It can impede the meeting of eggs and sperm, reducing the chances of pregnancy. Prolonged PID may lead to the formation of scar tissue in the fallopian tubes, which can also affect the transportation of eggs. Pelvic inflammatory disease can also impact the uterine lining, decreasing the chances of a fertilized egg implanting.

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