Tuesday, October 21, 2014

Pelvic Inflammatory Disease

Definition

Pelvic inflammatory disease (PID) is the generic term used to describe a variety of infections of the female inner reproductive organs (the uterus, ovaries and fallopian tubes).

Description

The following precise terms are used when indicating that areas are infected:

  • Endometritis is an infection of the endometrium or lining of the uterus.
  • Myometritis is an infection of the muscular layers of the uterus.
  • Salpingitis is an infection of the fallopian tubes.
  • Oophoritis is an infection of the ovaries.
  • Unilateral means to affect one side of paired structures, such as the tubes or ovaries.
  • Bilateral means to affect both sides of paired structures, such as the tubes or ovaries.
  • Pelvic abscess is a walled-off pocket of infection in the pelvic cavity.
  • Peritonitis is an infection of the peritoneum, a thin, strong membrane that lines the abdominal cavity.

PID can lead to infertility, ectopic pregnancy, chronic pelvic pain, and other serious consequences. If untreated, PID may lead to serious complications, including life-threatening abdominal abscess, infection of the abdominal cavity (peritonitis) and septicemia (blood poisoning).

Causes

PID is caused by a bacterial infection that moves from the lower genital tract, which consists of the vagina and cervix. It then moves into the uterus, up the fallopian tubes and finally, into the ovaries. The bacterial infection causes inflammation of the tissues, leaving them red and swollen.

Several organisms can cause PID. In most cases, it is caused by chlamydia or gonorrhea, two very common sexual transmitted diseases (STDs). However, other kinds of bacteria and bacterial infections, such as bacterial vaginosis, anaerobes, enteric gram-negative rods and streptocci, can be associated with PID.

Symptoms

Women may experience any of the following symptoms:

Diagnosis

Since PID can be asymptomatic (without symptoms) or symptomatic, there is no standard diagnostic procedure. If the doctor suspects PID, a physical examination is given, as well as a pregnancy test (to rule out an ectopic pregnancy), a white blood cell test (to rule out appendicitis), and a genital culture (to look for gonorrhea and chlamydia).

If more information is needed, the doctor may order an endometrial biopsy (tissue sample removed from the endometrium), a sonogram (if abscesses are suspected), a culdocentesis (fluid sample taken from uterine sac), or laparoscopy.

Laparoscopy is considered the "gold standard" for diagnosis of PID, because it allows visualization of the pelvic organs. The procedure involves inserting a tiny, flexible lighted tube through a small incision just below the navel. This allows the doctor to view the internal abdominal and pelvic organs and determine the cause of the infection. This procedure is recommended when results of the preliminary tests (physical exam, blood tests and cultures) are unclear.

Treatment

Treatment will depend on how severe the infection is. According to experts in the treatment of PID, as well as personnel at the Center for Disease Control (CDC), a patient with PID should be hospitalized if any of the following criteria apply:

  • Diagnosis of PID is uncertain
  • Follow-up within 36-48 hours is possible only if hospitalized
  • High fever (38.3-40.0 degrees C, 101-104 degrees Fahreheit)
  • It has been impossible to rule out surgical emergencies, such as appendicitis and ectopic pregnancy
  • Another severe illness is present that could complicate the course of PID or have an adverse effect on treatment
  • The patient is prepubertal
  • Outpatient therapy has been ineffective
  • Pelvic abscess is suspected

If hospitalization is not necessary, antibiotics are prescribed immediately, since delaying treatment is risky. CDC recommends the following antibiotic treatments:

  • Injected cefoxitin (Mefoxin) and probenecid (Benemid) tablets or;
  • Injected ceftriaxone (Rocephin) and oral doxycline (Vibramycin or Doryx) or tetracycline (Achromycin V or Sumycin) for 14 days or;
  • Ofloxacin tablets (Floxin) and oral clindamycin (Cleocin HCI) or metronidazole (Flagyl) for 14 days.

In addition to the drug treatment, bed rest and plenty of liquids are recommended. Sexual intercourse should be avoided until recovery is complete (often for two to three months).

Subsequent use of a condom or a diaphragm with spermicide and abstaining from sexual intercourse during the menstrual cycle may reduce the risk of reinfection.

Whichever drug regimen the doctor chooses, a follow-up in two or three days is necessary to ensure that the medications are working. If the antibiotics are not effective, the doctor may suggest hospitalization where intravenous antibiotics will be administrated.

Surgery may be required if tubo-ovarian abscesses, an overwhelming infection or intractable pelvic pain are evident.

Male sexual partners - even asymptomatic ones - should be treated for gonorrhea and chlamydia, since a successfully treated woman may become reinfected by an infected partner. Treatment for male partners involves the same treatment as for women.

Questions

Do any tests need to be done to diagnose or to determine the cause and what has been affected by the disease?

Does a laparoscopy need to be performed? If so, is this performed in the hospital? Under a local or general anesthetic? What are the possible complications? What is the procedure?

What is the cause of the PID?

What organs are infected?

How serious is the condition?

Are there any possible future consequences or complications?

What are the chances of infertility? Are there tests to determine infertility?

What treatment will you be recommending?

Will you be prescribing any medications? What are the side effects?

What measures can be taken to help decrease the pain?

Are there any signs or symptoms that should be reported to the doctor immediately?

How long should sexual intercourse or douching be avoided?

Prevention

  • Abstain from sexual intercourse or have a mutual monogamous relationship (having a sexual relationship with one partner who is only having sex with you).
  • Use a barrier contraceptive (i.e., diaphragm and condom) during sex.
  • If you think you have a sexually transmitted disease, get tested. Early treatment may prevent the development of PID.
  • If treated for PID, follow the doctor's instructions and take all the medicine prescribed to you. Do not stop when the symptoms go away. The infection sometimes remains active, even after symptoms go away.