Pelvic Inflammatory Disease (PID)
Description of the disease
This is an acute clinical syndrome caused by microorganisms entering the uterine mucosa from the vagina, cervix (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), pelvic peritoneum covering the organs (peritonitis), and other nearby organs. The most characteristic is salpingitis (inflammation of the fallopian tube). PID is a common and difficult to diagnose disease in fertile-age women – 1% of women aged 15-39 are affected each year. The causative agents of PID:
a) sexually transmitted disease pathogens – chlamydia, gonorrhea pathogens;
b) other microorganisms – Escherichia coli, streptococci, mycoplasmas, bacterial vaginosis pathogens.
Risk Factors for Developing Inflammation
Several risk factors significantly contribute to the development of inflammation, particularly pelvic inflammatory disease (PID):
- Sexually Transmitted Diseases (STDs): Infections like chlamydia and gonorrhea are major causes of inflammation.
- Lack of Contraception Use: Not using contraceptive methods, particularly barrier methods like condoms, can increase the risk of infection.
- Early Sexual Intercourse: Initiating sexual activity at a young age raises the risk.
- Young Age: A significant percentage (75%) of cases occur in women under 25 years of age.
- Frequent Changes of Sexual Partners: Having multiple sexual partners heightens the risk of contracting infections that lead to inflammation.
- Vaginal Douching: Douching can disrupt the natural balance of bacteria in the vagina and increase the likelihood of infection.
- Low Social Status: Socioeconomic factors can limit access to healthcare and educational resources, thereby increasing risk.
- Smoking: Smoking doubles the risk of developing inflammatory conditions.
- Previous PID: Having had pelvic inflammatory disease before makes a woman more susceptible to recurrence.
- Untreated Sexual Partner: Failing to treat the sexual partner for STDs can lead to reinfection and ongoing inflammation.
Symptoms
Women experience lower abdominal and back pain that coincides with the middle or end of menstruation. The pain remains constant and intense and increases during physical exertion or sexual intercourse. Moreover, urination becomes disrupted, resulting in frequent and painful episodes. Additionally, malodorous vaginal discharge increases, and fever often occurs.
Diagnosis
Diagnosing this condition starts with evaluating symptoms and performing thorough laboratory and gynecological examinations. These examinations usually detect tenderness. If an abscess has formed, it becomes palpable during the exam. Additionally, doctors use instrumental examinations such as ultrasound and laparoscopy to better assess the condition of the uterus and its appendages and to identify any changes. Furthermore, if necessary, they take a piece of mucosa for a more detailed examination.
Treatment
The treatment primarily involves administering antimicrobial therapy with antibiotics from the penicillin group or stronger alternatives. If the condition does not improve, doctors treat the woman in a hospital. Additionally, if an abscess has formed, they drain its contents or remove the formation. Efforts are made to preserve fertility. However, if the ovaries and/or fallopian tubes are irreversibly altered, doctors remove them.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology