Pelvic inflammatory disease: causes, symptoms, and diagnosis

Pelvic Inflammatory Disease

Pelvic inflammation disease is the most prevalent sexually transmittable disease other than AIDS affecting more than a million women every year in the United States. The astounding fact is that every year more than 100000 cases of infertility and around 70,000 ectopal pregnancies are attributed to pelvic inflammation disease. PID is a genital tract infection that affects the uterus, fallopian tubes and the ovaries. Involving more than 250,000 hospitalizations in a year Pelvic inflammatory disease incurs an annual health care expense of around $4.2 billion. [

Stephanie Abbuhl]. The infection affects the pelvic structures like fallopian tubes, ovaries, bowel and the entire peritoneal cavity. Though infection of the upper genital tract by Chlamydia trachomatis and Neisseria gonorrhoeae are identified to be the primary cause other pathogens are also indicated in the pathology of the disease. In view of its transmittable nature and increasing prevalence a good understanding of the nature of the disease, preventive measures and treatment methods are important in the control of the disease.

Pathophysiology

As the name indicates the disease involves inflammation of the upper genital tract. Chlamydia trachomatis and Neisseria gonorrhoeae are the major causative agents for PID. These pathogens cause damage to the epithelium increasing the chances of infection from other opportunistic microbes. These pathogens reach the upper genital tract through the vagina and the cervix resulting in pelvic inflammatory disease. However, infections from other bacteria such as Peptococcus, Peptostreptococcus, and Bacteroides are also known to cause inflammation of the genital tracts. Researchers have also confirmed the presence pathogenic prokaryotes like mycoplasma and ureaplasma in the genital tract of the affected women.

Risk factors

PID predominantly affects sexually active young women who have multiple sexual partners. Women with a previous history of PID or with other STD's such as gonorrhea or Chlamydia are more prone to acquire pelvic inflammatory disease. It is observed that douching practice among women increases the chances of passing on the bacteria into the upper genital regions. The use of intrauterine device has also been identified to be a risk factor for acquiring PID. [NIAID] Further, research evidence suggests that teenagers are at a greater risk of getting affected by this disease compared to older women. Increasing number of young adolescent girls infected with PID attests this claim. [Famolare]

Symptoms

Two important symptoms of PID include abdominal pain and unusual increase in vaginal discharge. Upper abdominal pain and lower back pain are also common symptoms. In some people fever, nausea, vomiting may be attendant symptoms. Since the etiology of PID is varied the appearance of symptoms is also differentiated. Some patients are asymptotic and hence it is much difficult to find out the infection at an early stage. For example in gonorrhea and Chlamydial PID symptoms are manifest only in the post menstrual days. Sudden onset of symptoms is a common feature in Gonococcal PID as against non-Gonococcal PID. [

Stephanie Abbuhl]

Common treatment modalities

Antibiotics constitute the mainstay treatment for pelvic inflammatory disease. Treatment for PID presents two main problems. First, obtaining the specimens from the upper genital tracts is difficult. Second, the infection may be attributed to multiple pathogenic agents all of which may not respond to a prescribed medication. Physicians in general prescribe a combination of antibiotics to fight the infection. Cefoxitin, Clindamycin, Ofloxacin, ciprofloxacin and ampicillin are some of the commonly prescribed antibiotics in the treatment of PID. The safety of the drug for use during pregnancy must be ascertained before beginning the course. Also it is necessary as a preemptive measure to treat sexual partners in order to completely eliminate the possibility of reinfection. In acute cases where there is severe damage to the peritoneal tissues or bursting of abscess, surgical interventions are necessary. Intrauterine devises need to removed be in order not to increase risk of reinfection. [

Stephanie Abbuhl]

Conclusion

Pelvic inflammatory disease is a highly transmittable and serious condition which requires timely diagnosis and appropriate treatment. The risk of ectopal pregnancy is tenfold in women with a previous history of PID. Further, delayed diagnosis and treatment will result in poor prognosis and serious complications such as infertility and chronic pelvic pain. Though having a single sex partner is the best way to avoid the problem resorting to safe sex methods would drastically reduce the chances of catching the infection. While research is still underway in developing good diagnostic and effective treatment methods a common sense approach to contain the spread of the disease would be to maintain sexual hygiene and follow precautionary measures.