Introduction

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

Risk factors

STD

  • 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
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

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