Pelvic inflammatory disease

Pelvic inflammatory disease (or disorder) (PID) is a generic term for infection of the female uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to tissue necrosis with/or without abscess formation. Pus can be released into the peritoneum. 2/3 of patients with laparoscopic evidence of previous PID were not aware they had had PID (Cecil's 5th ed). PID is often associated with, because it is a common result of infection with, sexually transmitted diseases. PID is a vague term and can also refer to viral, or fungal, or parasitic, but usually with bacterial infections. more...

PID should be classified by affected organs, the stage of the infection, and the organism(s) causing it. Although very commonly a sexually transmitted infection is the likely cause, other routes are possible for some agents including lymphatic, often postpartum, postabortal (either miscarriage or abortion) or IUD related, and hematogenous spread.

Epidemiology

In the United States, more than one million women are affected by PID each year, and the rate is highest with teenagers. Approximately 50,000 women become infertile in the US each year from PID . N. gonorrhoea is isolated in only 40-60% of women with acute salpingitis (current obgyn 9th ed 2003). C. trachomatis was estimated by current obgyn 9th ed to be the cause in about 60% of cases of , which may lead to PID. It is unsure how much is due to a single organism and how much is due to multiple organisms; many other pathogens that are in normal vaginal flora become involved in PID. 10% of women in one study had asymptomatic Chlamydia trachomatis infection and 65% had asymptomatic infection with Neisseria gonorrhoeae (current obgyn 9th ed.) It was noted in one study that 10-40% of untreated women with N. gonorrhoea develop PID and 20-40% of women infected with C. trachomitis developed PID.(Cecil's essentials of medicine 5th ed.). "PID is the leading cause of infertility. A single episode of PID results in infertility in 13% of women." (Cecil's 5th ed.) This rate of infertility increases with each infection.

Diagnosis

There may be no actual symptoms of PID. If there are symptoms, 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 PID can occur and cause serious harm without causing any noticeable symptoms. Laparoscopic idenitification is helpful in diagnosing tubal disease, 65-90% positive predictive value in patients with presumed PID (current obgyn 9th ed 2003). Regular STD testing is important for prevention. Treatment is usually started empirically because of the terrible complications. 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 (cecil's 5th ed.).

Prognosis

Although the PID infection itself may be cured, effects of the infection may be permanent. This makes early identification by someone who can prescribe appropriate curative treatment so important in the prevention of damage to the reproductive system. Since early gonococcal infection may be asymptomatic, regular screening of individuals at risk for common agents (history of multiple partners, history of any unprotected sex, or people with symptoms) or because of certain procedures (post pelvic operation, postpartum, miscarriage or abortion). Prevention is also very important in maintaining viable reproduction capabilities. If the initial infection is mostly in the lower tract, after treatment the person may have little difficulties. If the infection is in the fallopian tubes or ovaries, more serious complications are more likely to occur.

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