Pelvic inflammatory disease - Causes, Symptoms and Treatments
Pelvic inflammatory disease (PID) is any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the cervix (cervicitis), uterus (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis), which can extend to the connective tissue lying between the broad ligaments (parametritis).
Early diagnosis and treatment prevents damage to the reproductive system. Untreated PID may cause infertility and may lead to potentially fatal septicemia, pulmonary emboli, and shock.
Causes of Pelvic inflammatory disease:
PID can result from infection with aerobic or anaerobic microbes. The aerobe, Neisseria gonorrhoeae, is its most common cause because it most readily penetrates the bacteriostatic barrier of cervical mucus.
Normally, cervical secretions have a protective and defensive function. Conditions or procedures that alter or destroy cervical mucus impair this bacteriostatic mechanism and allow bacteria present in the cervix or vagina to ascend into the uterine cavity; such procedures include conization or cauterization of the cervix.
Uterine infection can also follow the transfer of contaminated cervical mucus into the endometrial cavity by instrumentation. Consequently, PID can follow insertion of an intrauterine device (IUD), use of a biopsy curvet or of an irrigation catheter, or tubal insufflation. Other predisposing factors include abortion, pelvic surgery, and infection during or after pregnancy.
Bacteria may also enter the uterine cavity through the bloodstream or from drainage from a chronically infected fallopian tube, a pelvic abscess, a ruptured appendix, diverticulitis of the sigmoid colon, or other infectious foci.
Common bacteria found in cervical mucus are staphylococci, streptococci, diphtheroids, chlamydiae, and coliforms, including Pseudomonas and Escherichia coli.
Uterine infection can result from any one or several of these organisms or may follow the multiplication of normally nonpathogenic bacteria in an altered endometrial environment. Bacterial multiplication is most common during parturition, because the endometrium is atrophic, quiescent, and not stimulated by estrogen.
Signs and symptoms of Pelvic inflammatory disease:
Clinical features of PlD vary with the affected area but generally include a profuse, purulent vaginal discharge, sometimes accompanied by low-grade fever and malaise (particularly if gonorrhea is the cause). The patient experiences lower abdomen pain; movement of the cervix or palpation of the adnexa may be extremely painfuL
Diagnosis for Pelvic inflammatory disease:
Diagnostic tests generally include Gram stain of secretions from the endocervix or cul de sac. Culture and sensitivity testing aids selection of the appropriate antibiotic. Urethral and rectal secretions may also be cultured. Ultrasonography is used to identify an adnexal or uterine mass. (X-rays seldom identify pelvic masses.) Culdocentesis is performed to obtain peritoneal fluid or pus for culture and sensitivity testing. Complete blood count and pregnancy test should also be completed.
In addition, patient history is significant. In general, PID is associated with recent sexual intercourse, IUD insertion, childbirth, or abortion.
Other conditions to consider are appendicitis, ectopic pregnancy, ovarian cyst rupture, endometritis, ovarian torsion, inflammatory bowel disease, and diverticulitis.
Treatment of Pelvic inflammatory disease:
To prevent progression of PID, antibiotic therapy begins immediately after culture specimens are obtained. Such therapy can be reevaluated as soon as laboratory results are available (usually after 24 to 48 hours). Infection may become chronic if treated inadequately.
The guidelines of the Centers for Disease Control and Prevention (CDC) for outpatient treatment include ofloxacin and metronidazole for 14 days or ceftriaxone (or another third-generation cephalosporin) with doxycycline for 14 days. The CDC guidelines for inpatient treatment include doxycycline with a combination of clindamycin and gentamicin or cefotetan.
Development of a pelvic abscess necessitates adequate drainage. A ruptured abscess is life-threatening. If this complication develops, the patient may need a total abdominal hysterectomy with bilateral salpingo-oophorectomy, although laparoscopic drainage with preservation of the ovaries and uterus appears promising.
Special considerations and prevention tips of Pelvic inflammatory disease:
To prevent infection after minor gynecologic procedures, such as dilatation and curettage, tell the patient to immediately report any fever, increased vaginal discharge, or pain. After such procedures, instruct her to avoid douching and intercourse for at least 7 days.
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