Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infectious disease and inflammation of the upper female reproductive tract, including the uterus, fallopian tubes, and adjacent pelvic structures.

Pelvic inflammatory disease (PID) is initiated by an infection that ascends from the vagina and cervix. Chlamydia trachomatis is a sexually transmitted PID predominant organism causing. Newer, more accurate, studies have shown that laparoscopic this disease can often be polymicrobial in nature (30-40%). Other organisms that have been implicated in the pathogenesis of PID include Neisseria gonorrhoeae, Gardnerella vaginalis, Haemophilus influenzae, and anaerobes such as Bacteroides species and Peptococcus. (See Etiology).

At the time of presentation, women with PID can vary from asymptomatic to severe disease. The most common presentation is lower abdominal pain. Many women also show an abnormal vaginal discharge. The diagnosis of acute PID is primarily based on clinical and historical findings, but many patients may have few or no symptoms. (See clinical presentation.)

The classic high-risk patient is a menstruating woman younger than 25 years who has multiple sex partners, do not use contraceptives, and lives in an area with high prevalence of sexually transmitted diseases (STD).

The differential diagnosis includes appendicitis, cervicitis, urinary tract infection, endometriosis and adnexal tumors. PID is the most common incorrect diagnoses in cases of ectopic pregnancy. A pregnancy test is required in all women of childbearing age. A delay in diagnosis or treatment of Pelvic inflammatory disease can cause long-term sequelae such as tubal infertility and chronic pelvic pain. (See Differentials.)

PID can result in tubo-ovarian abscess (TOA) and extend to the production of pelvic peritonitis and Fitz-Hugh-Curtis syndrome (perihepatitis), as shown below.

"Violin-string" adhesions chronic Fitz-Hugh-Curtis syndrome.
Laparoscopy is the current standard criteria for the diagnosis of PID. No single test is highly sensitive and specific for the disease, but some laboratory studies that can be used to support the diagnosis include the erythrocyte sedimentation rate, C-reactive protein, and DNA probes to chlamydia and gonorrhea and cultures. Imaging studies, such as ultrasound, computed tomography and magnetic resonance imaging may also prove useful in cases unclear. (See Workup).

Empirical treatment is recommended by the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Disease Management Guidelines for patients with uterine tenderness or adnexal tenderness and cervical motion, if no other etiology, explains the results. All regimens of antibiotics should be effective against Chlamydia trachomatis and N gonorrhoeae, as well as against gram-negative organisms optional, anaerobes, and streptococci. Most patients are treated in the clinic, but doctors should consider hospitalization in selected cases. (See Treatment and Management.)