Pelvic inflammatory disease 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 – inflammation of the endometrium
- Young age (16-24)
- Multiple sexual partners
- Chlamyida / gonorrhoea
- 90% of pelvic inflammatory disease 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 pelvic inflammatory disease
- Bacterial vaginosis
- 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)
- The cervix will appear red and will bleed easily
- Chlamydia – endocervical swab
- Gonorrhoea – endocervical swab
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.
- Cervical excitation
- Tendernes / peritonism
- Tenderness at the fornices
- 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
- Abscess formation – occurs in up to 15% of patients. May cause severe pain and peritonitis. May rupture.
- 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.
- Consider swabs
- If very unwell, may have to admit for IV (usually ceftriaxone)Otherwise, 14 days doxycyline + metronidazole
Contact tracing – as per STI
- Avoid intercourse until patient and partner have been successfully treated