Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is caused by bacteria, or more uncommonly viruses, infecting the reproductive organs. It is a broad term that includes endometritis, salpingitis, perioophorosalpingitis, and abscess in the ovaries or pelvic peritonitis caused by abscess in the ovaries.

Pelvic inflammatory disease is often caused by sexually transmitted infections such as gonorrhea and trachomatis. Other anaerobic bacteria such as vaginalis, which cause bacterial vaginosis, can also lead to pelvic inflammatory disease. Such anaerobic causes infection through an imbalances in the normal flora within the vagina.

Diagnosis

In most people, PID is easily diagnosed if the patient has pelvic pain, motion tenderness (when the cervix is moved), and pressure pain in the adnexa. However, these clinical presentations often vary, which can make the diagnosis of PID more difficult.

Many women only experience mild symptoms, so diagnosis is challenging. The main aim of PID management is to diagnose even the mild cases and to avoid excessive use of antibiotics on those that have no infection. Other typical symptoms of PID include lower abdominal pain, increase in vaginal discharge, excessive periods, fever and urinary problems. Some patients may not have any symptoms at all.

Women with PID often experience pressure pain in the pelvic organs (such as the uterus) and motion tenderness. This is believed to be caused by the movement in the abdominal membrane when the cervix is used, causing pain.

It is important that the vaginal and the cervical discharge is tested when a woman is thought to have PID. Smear tests of the vaginal discharge often show an increase in white blood cells.

Women with severe symptoms may be investigated using different methods. These includes biopsy of the lining of the uterus, ultrasound examination and pelvic endoscopy.

Treatment

Broad-spectrum antibiotics that are effective in treating gonorrhea, trachomatis, and gram-negative anaerobes should be used.

Patients may need to be admitted to the hospital in some cases. This is when the diagnosis is unclear, if there is a suspected pelvic abscess, if the symptoms are severe, and if it is difficult to follow up the patient in the outpatient clinic.

When the fever subsides, the patient hasn’t had a fever for at least a day, the white blood cell count is normalized, there is no pressure pain in the pelvis and the patient is clinically better, the patient may be discharged.

It is also useful to check for urinary tract infections in the sexual partners of the patient with pelvic abscesses.

Untreated PID can sometimes cause abscesses in the fallopian tube and the ovaries. Patients with PID may have lumps in the pelvis on physical examination. This is often caused by lumpy ovaries, fallopian tubes or the bowels.

Treatment for abscesses in the ovaries and fallopian tube is best delivered in the hospital using appropriate antibiotics. With appropriate antibiotics, 75 percent of patients can be cured. If antibiotics are not effective, surgery should be considered.

By Kim Byoung-gie

The author is a doctor at the Department of Obstetrics and Gynecology at Samsung Medical Center and a professor of Sungkyunkwan University School of Medicine. ―Ed.