Pelvic Inflammatory Disease - PID

Original article by Tom Leach | Last updated on 28/5/2014
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Introduction

This is an inflammatory condition (often secondary to infection), affecting any part of the higher female reproductive system, e.g.; uterus, fallopian tubes, ovaries.
  • Salpingitis – this term is sometimes used interchangeably with PID, but technically only refers to inflammation in the fallopian tubes.
  • Endometritis
 

Risk factors

STD

  • Young age (16-24)
  • Multiple sexual partners
  • Chlamyida / gonorrhoea
    • 90% of cases are sexually acquired
    • Mostly due to chlamydia
    • Chlamydial infection is often less severe clinically than gonorrhoea. Gonorrhoea tends to cause more of an acute infection
    • 60% of chlamydia cases are asymptomatic
    • 10% of cases occur after childbirth, particularly if forceps are used.

IUD insertion
Previous PID
Bacterial vaginosis

 
Everybody having an IUD should be screened for infection before insertion to reduce the risk of PID – as the IUD can introduce the infection from the lower tract to the upper tract
 

Symptoms

Abdominal pain

  • Usually lower region
  • Can be bilateral or unilateral
  • If pain is severe, may be associated with nausea and vomiting. If nausea and vomiting are present, this suggests peritonitis.

Cervical / vaginal discharge
Irregular vaginal bleeding

  • Heavy blood loss suggests endometritis

Fever (About 1/3 of patients)
Cervicitis

  • The cervix will appear red and will bleed easily

OFTEN ASYMPTOMATIC!

 

Investigations

Swabs

Laparoscopy – if suspected complication that can be treated surgically

  • Also consider in patients who do not respond very quickly to antibiotic treatment – abscess may be present that needs draining.

Examination

  • Cervical excitation
  • Tendernes / peritonism
  • Tenderness at the fornices
 

Diagnosis

  • Should be suspected in any woman with lower abdo pain and unusual cervical / vaginal discharge
  • Should be consider in any woman with unexplained irregular bleeding
 

Complications

  • Abscess formation – occurs in up to 15% of patients. May cause severe pain and peritonitis. May rupture.
  • Infertility
  • Chronic pelvic pain
  • Ectopic pregnancy
  • Fitz-Hugh-Curtis Syndrome – inflammation of the liver capsule, secondary to PID
  • Chronic salpingitis – chronic infection of the fallopian tubes. Can cause fibrosis and adhesions. May occur if PID not treated prompty.
 

Treatment

Antibiotics

  • Consider swabs
  • If very unwell, may have to admit for IV (usually ceftriaxone)Otherwise, 14 days doxycyline + metronidazole

Contact tracing – as per STI
Advice

  • Avoid intercourse until patient and partner have been successfully treated