The World of Pregnancy

Pelvic Inflammatory Disease: Causes, Signs, Complications & Diagnosis!

Pelvic inflammatory disease (PID) is the result of an ascending vaginal infection that affects the uterus, fallopian tubes, ovaries, pelvic cavity parameters and then the rest of the pelvic cavity, sometimes propagating up into the abdomen.

It`s considered a STD, but may occur as a result of invasive maneuvers at the uterine level through the use of contaminated instruments or vaginal flora dislocation.

It starts as an asymptomatic infection during a relatively long period of time, which may lead to female infertility, pelvic abscess, peritonitis, and can even be fatal in rare cases.

Causes of Pelvic Inflammatory Disease

PID can be considered quite an unpleasant complication of infection with Chlamydia trachomatis or Neisseria Gonorrhoeae, and other microorganisms with secondary role as Ureaplasma urealyticum. It often is a polymicrobial infection that requires a long treatment and subsequent verification by the gynecologist.

The most important risk factor is an active sexual life with several partners and no protection. The probability of getting this STD is rather high.

Also, some invasive uterine maneuvers that can lead to PID may include:

  • Abortion.
  • Mounting an IUD device.
  • Hysterosalpingography.
  • Cryotherapy and electrocautery cervicitis.
  • Conization.

Other causes may include:

  • Vaginal showers.
  • Improper hygiene and underwear.
  • Recent menstruation.
  • History of vaginal infection.

A weak immune system favors the expansion of the infection in people with debilitating diseases, diabetes, and those undergoing chemotherapy. – Check this!

Signs & Symptoms

In most cases, a pelvic inflammatory disease has a long asymptomatic evolution, of course, depending on the infectious agent and the immune system. When the symptoms appear, they could vary from mild for severe, painful signs.

The most common symptom is pain in the lower abdomen. This may occur suddenly, it may be accentuated when walking and during sexual contact. The pain may be in the form of cramps, or as a constant pressure and local irritation. The pain may also be experienced when urinating.

Other signs may include:

  • Mild or high fever.
  • Vaginal discharges with bad odor.
  • Intermenstrual bleeding.
  • Strong menstrual pains.
  • The expansion of upper abdomen pain accompanied by nausea, vomiting, constipation and bloating.

Complications

At present, a lot of women who aren`t able to conceive receive a diagnosis with PID, infertility being a complication of the disease due to the fallopian tubes being affected. It`s estimated that up to 10% – 15% from women with this disease may become infertile in this way.

Ectopic pregnancy occurred due to PID affects 10% of patients and 20% from them manifest chronic pains.

A complication, which can be deadly, is the formation of abscesses not only in the fallopian tubes, but also in the perihepatic upper abdomen. Breakage of these abscesses may lead to acute peritonitis that requires immediate surgery.

Diagnosis

Diagnosis can be made by the gynecologist and family doctor, emergency physician or internist after correlating the imaging and laboratory investigations with anamnesis. Usually, the gynecologist is the one monitoring the treatment of PID and its complications.

When anamnesis is involved, the patient shares the symptoms and then the doctor observes the vaginal sensitivity. An ultrasound offers little data, but it may see any developing abscesses. Lab tests may reveal signs of infection, and the examination of vaginal secretion may identify the concerning germs. It can also be done an exploratory laparoscopy surgery.

Prior to PID diagnosis, a differential diagnosis is required; for example, other causes of acute abdomen – appendicitis. Also, the doctor will perform a pregnancy test to check if there`s an ectopic pregnancy installed.

Treatment

The sooner is this disease diagnosed and there are no complications, the more efficient is the treatment and easier to be tolerated by the patient.

First of all, the IUD device is removed if it exists, and any sexual contact will be avoided.

In most cases, the treatment involves drugs, but systematic antibiotic as well as treatment with pessaries. It takes 14 days and what is important is to return to a new medical consultation after 3 days, then in 1 week and then again in 2 weeks, so that the doctor can track the evolution of the disease.

Usually, the symptoms disappear completely after 3 – 5 days, and patients consider that they should stop treatment, but it`s mandatory to comply with the doctor`s instructions. The infection is polymicrobial, and its expansion is rather high, so it`s necessary a longer period of time for the drugs to act. After 6 weeks, it`s recommended a new medical investigation to confirm the healing.

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Patients may also take analgesic/anti-inflammatory drugs to control the pain and fever.

In some situations, treatment lasts more than 2 weeks and it may require hospitalization if the patient`s situation demands it or there are complications. Antibiotic treatment can be administered intravenously; abscess is drained under ultrasound guidance; adhesions on the fallopian tubes can be resolved laparoscopically for fertility re-installation.

It can be intervened surgically in cases of peritonitis and other complications. At the same time, the partners need to follow a treatment with medication to prevent any new infection or transmission to other people.

Prevention

A method of avoiding the occurrence of this disease is to prevent STDs, so it`s recommended to use condoms if the woman isn`t in a monogamous relationship. There`s no efficient screening for PID, but screening can be made for the most implicated bacteria in this pathology: Neisseria Gonorrhea and Chlamydia trachomatis infections associated with proper treatment for the infection.

In conclusion, pelvic inflammatory disease is a general complication of a STD, so they both can be prevented by using a condom. The symptoms are rarely present from the beginning, but if a medical investigation is made as fast as possible, future complications can be avoided. Treatment generally includes medication, and rarely surgery.

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