Pelvic inflammatory disease is a very common gynaecological problem of young sexually active women and occur’s due to infection in the lower genital organ (vagina) and the upper genital organs – uterus, cervix, tubes and ovaries.
Chlamydia and N. Gonorrhoea are commonest causative micro-organisms for PID and spread by sexual contact. If diagnosed early and treated promptly dreadful complications can be prevented like infertility (inability to conceive), ectopic pregnancy (pregnancy other than uterus& common site is tube), chronic pelvic pain, dyspareunia (painful coitus) & persistent vaginal discharge.
Rarely PID occurs due to spread of infection through blood (tuberculosis) or lymphatic (spread of infection from IUD)
Risk factors for Pelvic Inflammatory Disease:
High risk factors for PID are sexual exposure at younger age, multiple or symptomatic sexual partners, instrumentation of genital tract during minor surgeries like dilatation and curettage, dilatation and evacuation , insertion of intrauterine device and previous history of PID or STD.
Symptoms of Pelvic Inflammatory Disease :
Women with PID may remain asymptomatic or present with life threatening complication like tubo-ovarian abscesses. Common symptoms are lower abdominal pain, discharge per vaginum, fever, dyspareunia, dysuria or post coital bleed.
How is Pelvic Inflammatory Disease diagnosed?
Diagnosis is mainly clinical, but cervical swabs for Chlamydia and gonorrhoea may be helpful. Since the long term effects of PID are very detrimental, it is advised that treatment should be started at first clinical diagnosis without waiting for results of swab tests.
Treatment of Pelvic Inflammatory Disease :
For milder cases, a single dose of antibiotic (ceftriaxone 250mg) followed by a 14 days course of Doxycycline with or without Metronidazole may be given. In cases with advanced disease, hospitalisation may be necessary and intravenous antibiotics for 24 to 48 hours should be given. In case of tubo ovarian abscess, apart from intravenous antibiotics, surgery may also be required.
Women with HIV have higher rates of concomitant M.hominis and streptococcal infection and also more chances of tubo-ovarian abscess. In all cases of PID (mild or severe) treatment of male partner is mandatory. In males, the infections are usually asymptomatic and may act as portal of infection.
Also, emphasis should be given on abstinence or use of barrier contraception (condoms) during the course of treatment and Sex education of adolescence also help in preventing PID.