Pelvic inflammatory disease

 PELVIC INFLAMMATORY DISEASEDescriptionPelvic inflammatory disease is a bacterial infection of the upper female genital tract, including the uterus, fallopian tubes, and the ovaries.The infection is called endometritis when it is present in the lining of your uterus, salpingitis if it involves the fallopian tubes. If the infection is severe, it can spread to the ovaries, in this case it is called oophoritis or it can produce a collection of pus in the fallopian tubes, hence the name tubo-ovarian abscess.Pelvic inflammatory disease is the most common preventable cause of infertility worldwide. Infertility occurs in about one of five women with pelvic inflammatory disease. About one third of women who have had pelvic inflammatory disease develop the infection again.SymptomsSymptoms start to be noticed toward the end of the menstrual period or during the few days after it. For many women, the usual symptoms are fever, chills, lower abdominal pain and pelvic pain; other symptoms include irregular vaginal bleeding and a vaginal discharge, which is sometimes accompanied with a bad odor.As the infection spreads, the lower abdomen becomes increasingly severe and may be accompanied by a low-grade fever (usually below 102° F [38.9° C]) and nausea or vomiting. Soon, as the fever becomes higher, the discharge often becomes pus-like and yellow-green. Pain is usually felt during sexual intercourse or urination.The infection may be severe but causes mild or no symptoms. Symptoms due to gonorrhea tend to be more severe than those of a chlamydial infection, which progresses more slowly and may not produce a discharge or any other visible symptoms.If infected, the fallopian tubes may become blocked. Blocked tubes may swell because fluid is trapped. This result in pressure or chronic pain in the lower abdomen.The infection can spread to the membrane that lines surrounding structures in the abdominal cavity causing peritonitis. Peritonitis can cause sudden or gradual severe pain in the entire abdomen.If infection of the fallopian tubes is due to gonorrhea or a chlamydial infection, it may spread to the tissues around theliver. Such an infection may cause pain in the upper right side of theabdomen. The pain is similar to that of a gallbladder disorder or stones. This complication is called the Fitz-Hugh-Curtis syndrome.An abscesscavity[containing pus] forms in the fallopian tubes or ovaries of about 15% of women whosefallopian tubes have been infected, especially if infection is present for a long time. An abscess sometimes ruptures, and pus spills into the pelvic cavity causing peritonitis, creating severe pain in the lower abdomen, swiftly followed by nausea, vomiting, and very low blood pressure (shock). The infection may spread to the bloodstream (a condition called sepsis) and can be fatal.Causes and Risk factorsPelvic inflammatory disease is caused by several different aerobic (oxygen-requiring) and anaerobic (non-oxygen-requiring) bacteria.The two most common such bacteria are Neissera gonorrhea, the bacterium that causes gonorrhea, and Chlamydia trachomatis, the bacterium that causes Chlamydia. Often times, the bacteria are transmitted during sexual intercourse with a partner who has a sexually transmitted disease. Gonorrhea and chlamydial infection typically spread from the vagina to the cervix, where they cause infection (cervicitis). These infections can either remain in the cervix or spread upward, thus causing pelvic inflammatory disease.The disease can also be caused by the bacteria that cause bacterial vaginosis. These bacteria normally reside in the vagina. They cause symptoms and spread to other organs only if they increase in number (overgrow). They are not sexually transmitted.Less commonly, women are infected during a vaginal delivery, an abortion, or a medical procedure, such as dilation and curettage (D and C) or gynecologic surgery— these are times when bacteria are introduced into the vagina or when bacteria that normally reside in the vagina are moved into the uterus.Pelvic inflammatory disease usually occurs in sexually active women. It rarely affects girls before their first menstrual period (menarche) or women during pregnancy or after menopause.Risk factors:- Age of 24 years or younger- Unprotected sexual activities- Multiple sex partners- Having a sexually transmitted disease or bacterial vaginosis- Having had pelvic inflammatory disease before- Poor or a lower socioeconomic status (with less access to health care)DiagnosisPID is usually diagnosed on the basis of existing symptoms like lower abdominal pain, orthe presence of an elevated white-blood cells count, and a positive bacterial culture of the cervical discharge; a sample of fluid (swab) is usually taken from the cervix and tested to determine whether the woman has gonorrhea or a chlamydial infection.A pregnancy test is done to see whether the woman may have a tubal pregnancy, which could be the cause of the symptoms.Ultrasonography of the pelvis may be carried out to assess the fallopian tubes or ovaries.In some instances, PID may be confused with illnesses such as appendicitis and a twisted or ruptured ovarian cyst. In this case, laparoscopy may be necessary to make the appropriate diagnosis, using a small incision beneath the navel through which the inside of the abdominal cavity is viewed and a sample of fluid is obtained for testing.PreventionBecause of the critical complications of PID, it is essential to prevent its onset. The only foolproof way to do this is abstaining from sex. However, if a woman has sexual intercourse with only one partner, the risk of pelvic inflammatory disease is very low, as long as neither partner is infected with the bacteria that cause sexually transmitted diseases.Barrier contraception of birth control (such as condoms) and spermicides (such as vaginal foams) can also help prevent pelvic inflammatory disease.Treatment and MedicationAntibiotics for gonorrhea and chlamydial infection are the usual treatment and are administered by mouth or by injection into a muscle.Oral doxycycline and metronidazole is taken for 10 to 14 days; intramuscularly, ceftriaxone could be given.In the hospital, antibiotics are given intravenously.If needed, the antibiotics can be changed after test results are available. Most women are treated at home. However, the woman should be hospitalized if:
  • The infection does not lessen within 48 hours
  • Symptoms are severe
  • The woman may be pregnant
  • An abscess is detected
Abscesses which persist despite treatment with antibiotics may be drained. Often, a needle can be used. It is inserted through a small incision in the skin, and an imaging test, such as ultrasonography or computed tomography (CT), is used to guide the needle into the abscess. A ruptured abscess requires emergency surgery.If under treatment, please refrain from sexual intercourse until antibiotic therapy is completed even if symptoms disappear; a confirmation that the infection iscompletely eliminated is needed. All recent sex partners should be tested for gonorrhoea and chlamydial infection and treated. If pelvic inflammatory disease is diagnosed and treated promptly, a full recovery is more likely to happen. 

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