Pelvic inflammatory disease

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Pelvic inflammatory disease (PID) is a broad term that describes an infection affecting the female reproductive organs, specifically the uterus, fallopian tubes, and ovaries. PID is typically associated with sexually transmitted infections (STIs), but other causes and routes of infection are also possible. It often progresses to scar formation and adhesions, which can lead to tissue necrosis and abscess formation. If untreated, PID can have serious long-term consequences, including infertility.

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Etiology and Classification

Most cases of PID are caused by bacterial infections, including those associated with STIs like Neisseria gonorrhoeae and Chlamydia trachomatis. However, PID can also be caused by viral, fungal, or parasitic infections. It is also possible for a mix of pathogens to cause PID, especially when the normal vaginal flora becomes disrupted.

Pelvic exam - Medical Record 1896

PID can occur through various routes, including sexual transmission, hematogenous spread, lymphatic dissemination, or following certain events like childbirth, miscarriage, abortion, or the insertion of an intrauterine device (IUD). Therefore, PID is classified according to the affected organs, the stage of the infection, and the causative organisms.

Epidemiology

In the United States, over a million women are affected by PID annually, with the highest rates observed among teenagers. PID is a major cause of female infertility, with approximately 50,000 women becoming infertile each year in the U.S. due to PID. Furthermore, PID is often asymptomatic, contributing to its potential for serious, long-term health consequences.

Diagnosis

PID can often be asymptomatic or present with vague symptoms, including lower abdominal pain, abnormal vaginal discharge, painful intercourse, irregular menstrual bleeding, and cervical motion tenderness. In some cases, the disease can progress significantly without producing noticeable symptoms, making its detection and treatment challenging.

Diagnosis of PID usually involves a combination of clinical evaluation, laboratory tests, and imaging studies. In particular, laparoscopic examination is helpful in diagnosing tubal disease associated with PID. Confirmation of PID may require histopathologic evidence of endometritis, visualization of filled or thickened fallopian tubes, or specific laparoscopic findings. A Gram stain of cervical discharge or endocervical specimens may help identify causative organisms.

Prognosis and Treatment

Despite PID being curable, its long-term effects can be permanent if diagnosis and treatment are delayed. Consequently, early detection and appropriate treatment are critical to preventing damage to the female reproductive system.

The standard treatment for PID usually involves a course of broad-spectrum antibiotics to cover the most common bacterial pathogens. Despite treatment, if the infection is severe or involves the upper reproductive tract (fallopian tubes or ovaries), serious complications like chronic pelvic pain, ectopic pregnancy, or infertility may occur.

Preventive measures, including regular screening for STIs and safe sex practices, play a crucial role in reducing the risk of PID and maintaining reproductive health. Regular screening is particularly important for individuals at high risk, such as those with multiple sexual partners, a history of unprotected sex, or post pelvic operation.

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References

• Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.
• Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am. 2013;27(4):793-809