Pelvic inflammatory disease (PID)

Pelvic inflammatory disease (PID) is a disease of genital tract typically involving uterus, fallopian tubes, ovaries and pelvic peritoneum. It is a disease of the reproductive years so most patients are young (70-80% of cases are under 25 years) and are sexually active (85-95% of infections are sexually acquired). The two organisms most commonly associated with PID (60% of cases) are Chlamydia trachomatis and Neisseria gonorrhea’s.

 Acute PID

• Patient has generalized symptoms
• Lasts a few days
• May recur in episodes
• Very infectious in this stage

 Chronic PID

Follows inadequately treated acute Pelvic inflammatory disease (PID)

• Patient may have no symptoms
• Occurs over months and years
• Progressive organ damage & change

Risk factors of PID

• Age of 1^st intercourse
• Multiple sexual partners
• Intrauterine contraceptives devices users
• Absence of contraceptive pill use
• Smoking is also noted to be associated with an increased risk of PID.

Sign and Symptoms of PID

Broad spectrum of disease included under the term pelvic inflammatory disease (PID), ranging from an acute, life-threatening presentation to a more chronic but disabling disorder.

• Fever
• Abnormal vaginal discharge
• Abnormal uterine bleeding
• Lower Abdominal pain 
• Painful sexual intercourse
• Malaise
• On vaginal examination, cervical motion tenderness and adnexal tenderness

Investigation  of PID

1. Blood test
   1. FBC (full blood count) – looking for a raised white blood cell count as response to infection
   2. ESR > 15 mm/hour
   3. serology for syphilis should be carried out for both the partners in all cases
2. Triple swabs – from high vagina, endocervix, urethra
3. Diagnostic laparoscopy – may be considered for a definitive diagnosis, investigation of a pelvic mass,  or failure to respond to treatment.

Male partner should also be investigated with smear and culture of urethral secretion.

Differential diagnosis of PID

• Appendicitis
• Ectopic pregnancy
• Urinary tract infection
• Endometriosis

Complication of PID

• Chronic Pelvic Pain (15-20 %)
• Ectopic pregnancy (10 fold ↑Risk)
• Infertility (Tubal)
• Recurrence of acute PID at least 25%

Acute PID Treatment 

Acute pelvic inflammatory disease (PID) should also include treatment of the sexual partner(s) as more than 50% will have evidence of genital tract infection. 

1. Broad spectrum antibiotics
   • Levofloxacin 500 mg once a day or
   • Metronidazole 500 mg thrice a day for 14 days or
   • Doxycycline 100 mg twice a day for 14 days
   • Intravenous antibiotics in case of inpatient treatment
2. Analgesic 
3.  Adequate rest

Indications for Admission

• Surgical emergency cannot be excluded
• Clinically severe disease (severe illness, peritonitis, nausea and vomiting, or high fever)
• Tubo-ovarian abscess (at least 24 hour observation)
•  PID in pregnancy
• Lack of response to oral therapy (within 72 hours)

Follow up for PID

• Partner or sexual contact tracing and testing or treatment
•  Look for other STD’s
• Lower genital tract infection
•  Counseling and support
• Pregnancy care

Prevention of PID

• Screen & treat asymptomatic disease
•  Sexual health counseling
•  Barrier contraceptives example condom

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