Pelvic inflammatory disease (PID) means infection or inflammation of the upper genital tract i.e. the ovary, the fallopian tubes and the uterus. It is generally seen in young sexually active females.
Cause: There are several natural barriers which resist the ascent of the causative organisms from the vagina upwards e.g. intact hymen, acidity in vagina, etc. Most of the pelvic inflammatory disease is caused by sexually transmitted microorganisms, mainly Neisseria gonorrhoeae and Chlamydia trachomatis. Less frequently other organisms can also cause it. Endogenous microorganisms (i.e. which are found in vagina) are also often responsible for pelvic inflammatory disease as they can alter the vaginal flora and acidity which may facilitate the ascending spread of infection.
When a virgin girl presents with pelvic inflammatory disease it is usually tubercular in nature. In India and other developing countries pelvic inflammatory disease may be often caused by improper hygiene during delivery and unhealthy septic abortions done by untrained dais. Even minor operative procedure like D & C, Hysterosalpingography (tubal patency test), and manual removal of placenta can cause pelvic inflammatory disease. Intra-uterine contraceptive devices may also increase the chance of pelvic inflammatory disease.
- Acute pelvic inflammatory disease-
- Symptoms: Acute pain, dull aching constant low abdominal pain, fever
- Chronic Pelvic inflammatory disease-
- Symptoms: Low backache, pain during intercourse, vaginal discharge; menstrual irregularity, infertility
Diagnosis is normally based on proper history and examination of patient. Detailed investigations e.g. pelvic ultrasound, blood counts, cervical and vaginal swab culture can pin point the exact cause of infection. Radiological investigations like CT and MRI may be needed in a few cases.
The choice of treatment depends on the extent of the underlying disease.
Medical: Antibiotics and pain killers can help initial cases; commonly used ones are Doxycycline, erythromycin, cephalosporins.
Minimal invasive surgery: It is required when the disease is extensive and invades the tubes and ovaries to form an abscess. Ultrasound guided aspiration or laparoscopic intervention may be required.
- In-hospital and hygienic delivery is ideal.
- Avoidance of septic abortions – Abortions / MTP to be performed in proper hygienic conditions and by trained persons.
- Barrier methods of contraception i.e. condom, prevent sexually transmitted diseases.
- Oral contraceptive pills especially minipills are also effective.
- In suspected cases Intra-uterine contraceptive devices (IUCD) should be avoided. Any vaginal infection should be treated prior to insertion of IUCD.
- Even female condom (Femshield) which covers cervix (uterine mouth) and entire vagina is highly effective in the prevention of infection.
- Early treatment with antibiotics in suspected cases