Pelvic Inflammatory Disease

Pelvic Inflammatory Disease refer to inflammation caused by an infection in the upper genital tract.This happen when infection when infection spread From the lower reproductive tract I.e.vaginaand cervix to the upper reproductive tract I.e.uterus, ovaries and fallopian tube.

It includes infection of:

1)Endometrium-Endometritis .

2)Oviducts-Salpingitis,most common PID.

3)Uterine wall -Myometritis.

4)Uterine serosa and broad ligament-parametritis.

5Pelvic peritoneum.

Causative organisms:

Usually a polymicrobial infection

N.gonorrhea,C.Trachomaatics- more commen

Other-E.coli, Streptococcus, klebsiella, Anaerobic bacteria....

Pathology-

Pelvic infection are acute not Chronic; results from ascending infection from the bacteria flora of the vagina and cervix in more than 99%of cases.This ascending infection occurs along the mucosal surface,where the bacteria colonize and infect the endometrium and fallopian tube.The process sometimes extended to the surface of the ovaries and nearby peritoneum and rarely into the adjacent soft tissue,such as the broad ligament and pelvis blood vessels.

Hematogenous and lymphatic spread to the tube or ovaries in another remote possibility.

The gonococcus produces an intense inflammatory reaction in the tubes, which cause narrowing or occlusion of the tube lumen because of the presence of necrotic debris and purulent material.Thise cellular destruction is much more extensive than the reaction associated with the Chlamydial infection.

When PID is the postmenopausal women, genital malignancies, diabetes,...,.

Risk factors-

1)Menstruating teenager

2)Female with multiple sexual partners

3)No use of contraception.

4)Induced abortion

5)IUD insertion.

Symptoms-

1)Irregular menstrual bleeding

2)Dysparenia

3)Abnormal vaginal discharge

4)Pain and tenderness in lower abdomen

5)High grade temperatures

6)Severe abdominal pain May found

Diagnosis-

1)Pelvic examination

2)Cultural and sensitivity of bacteria obtained directly from the site of the infection.

3)USG 

4)Culdocentesis

5Leproscopy

Management-

1)Antibiotic therapy

2)Treatment of the male partner.

3)Education for the prevention of disease

Complications-

1)Infertility

2)Ectopic pregnancy

3)Chronic pelvic pai..