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 sex 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.