Tuesday, September 1, 2015

PELVIC INFLAMMATORY DISEASE (PID)

Pelvic inflammatory disease (PID) is a disease of the upper genital tract. It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures. It is attributed to the ascending spread of microorganisms from the cervicovaginal canal to the contiguous pelvic structures. The clinical syndrome is not related to pregnancy and surgery.

But, as the terminology fails to pinpoint the precise organ or organisms involved, it is better to use the anatomical terminology in relation to which organ is involved in the infectious process. Thus, the better terminology should be either endometritis, salpingitis, pelvic peritonitis or tuboovarian abscess. The cervicitis is not included in the list. Many, however, prefer the term salpingitis as because it ultimately bears the brunt of acute infection. From a clinical perspective, it is more pragmatic to describe acute salpingitis as sexually transmitted or not.

Despite better understanding of the etiology, pathogenesis, improved diagnostic tools such as sonar or laparoscopy and advent of wide range of antimicrobials, it still constitutes a health hazard both in the developed and more so in the developing countries. The incidence of pelvic infection is on the rise due to the rise in sexually transmitted diseases. The ready availability of contraception together with increased permissive sexual attitude has resulted in increased incidence of sexually transmitted diseases and, correspondingly, acute PID.

The incidence varies from 1–2 per cent per year among sexually active women. About 85 per cent are spontaneous infection in sexually active females of reproductive age. The remaining 15 per cent follow procedures, which favors the organisms to ascend up. Such iatrogenic procedures include endometrial biopsy, uterine curettage, insertion of IUD and hysterosalpingography. Two-thirds are restricted to young women of less than 25 years and the remaining one-third limited among 30 years or older.

Pelvic inflammatory disease is a major problem to the reproductive health of young women. PID may be asymptomatic or subclinical. Currently there is certain changes in the epidemiology of PID. (A) Shift from inpatient PID to outpatient PID. (B) Change in clinical presentation. Less severe disease is commonly seen. (C) Shift in the microbial etiology of more Chlamydia trachomatis than gonococcus and others.
Risk factors
- Menstruating teenagers.
- Multiple sexual partners.
- Absence of contraceptive pill use.
- Previous history of acute PID.
- IUD users.
- Area with high prevalence of sexually transmitted diseases.
Teenagers have got low hormonal defence in response to genital tract infection. Wider area  of cervical epithelium allows colonisation of Chlamydia trachomatis and N. gonorrhoeae.
Protective factors
. Contraceptive practice
- Barrier methods, specially condom, diaphragm with spermicides.
- Oral steroidal contraceptives have got two preventive aspects.
- Produce thick mucus plug preventing ascent of sperm and bacterial penetration.
- Decrease in duration of menstruation, creates a shorter interval of bacterial colonization of the upper tract.
- Monogamy or having a partner who had vasectomy.

Patients with acute PID present with a wide range of non-specific clinical symptoms. Symptoms
usually appear at the time and immediately after the menstruation.
 Bilateral lower abdominal and pelvic pain which is dull in nature. The onset of pain is more rapid and acute in gonococcal infection (3 days) than in chlamydial infection (5–7 days).
 
There is fever, lassitude and headache.
 Irregular and excessive vaginal bleeding is usually due to associated endometritis.
 Abnormal vaginal discharge which becomes purulent and or copious.
 Nausea and vomiting.

 Dyspareunia.