The infection of female genital tract is called as Pelvic inflammatory disease. A majority of cases of PID are found in women.
genital tract involves the vagina, cervix, uterus (endometrium, myometrium)
fallopian tubes, and ovaries. The infection of female genital tract is called
as Pelvic inflammatory disease. It may be present in males but a higher
majority of cases of infection are
found in females.
‘Pelvic Inflammatory disease’ term explains the infection of either an
individual organ or infection ofall
the organs of female genitalia together.
the infection may occur in one part of genital tract and spread from there to
Pelvic inflammatory disease in women
Transmitted Diseases (STDs)
infections may be sexually acquired by few common organisms namely chlamydia,
Gonorrhoea. These microorganisms attack cervix and cause damage to the immune
system which helps in spreading of the infection inside the pelvis.
of the microorganisms may be caused by the drainage system (lymphatic system), blood
vessels or via infected sperms. Few cases have been seen to cause infection in
uterus with the use of contraceptive method which is most commonly used i.e.
Trachomatis, is a commonly found organism in sexually transmitted disease .It
affects women in the age range of 15-35 years most common in women under 27
years of age.
may present with purulent discharge mixed with mucus, pain in urination, inter-menstrual bleeding. It may be symptomless some times
as it is in men. Only 2-5% of females
present with symptoms.
mostly a silent infection that is not noticed by 50-70% of infected women. It
usually is symptomless but in few it may also present with painful urination,
purulent discharge from Bartholin’s glands (secretory glands of vagina to keep
of the times Chlamydia trachomatis occurs concurrently with Neisseria
Gonorrhoea and brings out the symptoms in females and both are usually treated
Births and Abortions
birth or abortions are also a source of infection of female pelvic organs and
introducing the microorganisms into her genitals. The most common causative
organism during childbirth or abortions is Staphylococci, streptococcus,
organisms are introduced through the cervical lacerations and through the placenta. Normal cervix
secretes mucus that forms a meshwork which prevents the spread of infections up
into the genitaliaand so do the
vaginal walls, they release acidic secretions that prevent the growth of
bacteria and therefore spread upwards into the genitalia.
(or child birth disrupt) is a normal protective mechanism of the cervix and
normal vaginal flora. It enhances the spread of infection deeper into the pelvic
organs. This is not an emergency and can be treated as an outpatient.
intrauterine devices used either for contraception purposes or devices used for
sexual satisfaction may lead to the infection of pelvic organs. Only 2-5% of
females develop infection due to this cause. Females who are introduced with
unsterilized instruments or devices are more prone to pelvic infections.
some studies it has also been seen that using intrauterine devices don’t cause
pelvic infections but the women who already have symptomless pelvic
inflammatory disease, the insertion of uterine device may accelerate its growth
and spread and may cause symptoms. Hence intrauterine device causes pelvic
women who are already carrying microorganisms in their vagina or cervix the
insertions of uterine device may help them carry up into the genitalia
spreading it into the uterus, infecting the uterus, fallopian tubes and
carries a very low risk of infection around 1-2%. Any gynaecological surgery
requiring the insertion of instruments which may not be sterilized may carry
micro-organisms along with it therefore causing infection.
few examples of minor surgical procedures that may cause infections are
Dilatation and curettage (D&C), dilatation and Evacuation (D&E),
few cases have also been found to cause infection via blood such as in
tuberculosis and peritonitis.
Symptoms of Pelvic Inflammatory Disease
pelvic inflammatory disease is symptomless and keeps growing until it is spread and gets
worse. Following are the symptoms when a woman has acute infection and requires
immediate medical attention:
Severe lower abdominal pain
Severe lower abdomen tenderness
High grade fever with chills
Abdominal muscle spasm
Pelvic pain and tenderness
Findings on Imaging
tests and endometrial sampling are done to detect the infection whereas it is
not an accurate test as ultrasound which locates the infection.
Trans-vaginal pelvic ultrasound is done to locate the infection and may be
helpful in detecting:
Pus or fluid filled fallopian tubes,
Free fluid in the pelvis
Potential laboratory tests to
medical laboratory tests need to be performed to help detect potential pelvic
inflammatory disease. These medical tests include:
Urethral and Endo-cervicalswab
for microscopy and culture helps in diagnosing the microorganism.
First void urine for screening of Chlamydia
Self collected genital swab
Treatment of PID
may be advised by the general practitioners to start the treatment of pelvic
inflammatory disease before the diagnosis of the exact causative organism.
with mild symptoms may be treated initially with single dose Probenecid 1g and
Ceftriaxone 250 mg
injection only single dose which may be followed by oral antibiotics
Doxycycline 100mg two times
a day for two weeks or 20 days .Your doctor may provide you with alternative
medications if the main line of treatment doesn’t work .
is the option for those women who may not respond well to the oral antibiotics.
Drainage is preferably done whereas complete removal of genital organs is
rarely required or indicated.
Prevention of PID
is better to prevent one from pelvic infections as its complications may be
long term. There are some ways to help you prevent PID from happening in the
first place. These include:
‘safe sex’ as Chlamydia and
Gonorrhoea both are sexually transmitted disease.
the number of sexual partners.
using condoms as it provides 90%
protection from sexually transmitted diseases. As these infections are
symptomless most of the times you may not know which of your partners has the
yourself screened for Chlamydia and
Gonorrhoea every six months. It helps keep a check on your health status
and better control of disease if occurred.
to avoid using devices that may harm your genitals as
lacerations and injuries are easier access for microorganisms to enter into the
genitalia and may cause spread of infections deeper into the pelvis.
initial untreated infection with Chlamydiamay
damage fallopian tubes in 15% of the cases and it increases as the number of
infections increases in woman and for how long it has been left untreated. By the third time of infection a
woman may lose up to 60% of her tubes.
Gonorrhoea may cause severe damage to fallopian tubes as compared to Chlamydia.
inflammatory disease may result in infertility, but not always. It has also
been found that women even with long standing infection may get pregnancy.
Ectopic pregnancy is more frequently found in many women
with PID as compared to women who don’t have it.
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