Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a clinical syndrome that results from the ascent of microorganisms from the cervix and vagina to the upper genital tract. PID can lead to infertility and permanent damage of a woman's reproductive organs.

How do women get pelvic Inflammatory disease?
Women develop PID when certain bacteria, such as chlamydia or gonorrhea, move upward from a woman's vagina or cervix into her reproductive organs. PID is a serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea.

What causes pelvic inflammatory disease?
A number of different microorganisms can cause or contribute to PID.

What are the signs and symptoms of pelvic inflammatory disease?
Women with PID present with a variety of clinical signs and symptoms that range from subtle and mild to severe. PID can go unrecognized by women when the symptoms are mild. Despite lack of symptoms, Pregnancy (including ectopic pregnancy) must also be excluded, as PID can occur concurrently with pregnancy.

When symptoms are present, the most common symptoms of PID are
Lower abdominal pain.
Mild pelvic pain.
Increased vaginal discharge.
Irregular menstrual bleeding.
Fever (>38° C).
Pain with intercourse.
Painful and frequent urination.
Abdominal tenderness.
Pelvic organ tenderness.
Uterine tenderness.
Adnexal tenderness.
Cervical motion tenderness.
Inflammation.

What are the complications of pelvic inflammatory disease?
Complications of PID include :
Tubo-ovarian abscess (TOA).
Tubal factor infertility.
Ectopic pregnancy.
Chronic pelvic pain.

Recurrent episodes of PID and increased severity of tubal inflammation detected by laparoscopy are associated with greater risk of infertility following PID.
Tubo-ovarian abscess (TOA) is a serious short-term complication of PID that is characterized by an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs.

Treatment includes broad-spectrum antibiotics with or without a drainage procedure, with surgery often reserved for patients with suspected rupture or who fail to respond to antibiotics. Women infected with HIV may be at higher risk for TOA

How is pelvic inflammatory disease diagnosed?
Presumptive treatment for PID should be initiated in sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum clinical criteria are present on :

1) Pelvic examination.
2) One or more of the following additional criteria.
oral temperature >101°F
abnormal cervical mucopurulent discharge.
presence of abundant numbers of WBC on saline microscopy of vaginal fluid.
The most specific criteria for diagnosing PID include.
3) Endometrial biopsy with histopathologic evidence of endometritis.
4) Transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic infection) or
5) Laparoscopic findings consistent with PID

LAPAROSCOPIC FINDINGS
Endometrial biopsy is warranted in women undergoing laparoscopy who do not have visual evidence of salpingitis, because endometritis is the only sign of PID for some women.
A serologic test for human immunodeficiency virus (HIV) is also recommended.
A pregnancy test should always be performed to exclude ectopic pregnancy.

How is pelvic inflammatory disease treated?
PID is treated with broad spectrum antibiotics to cover likely pathogens.
Antibiotic treatment does not, however, reverse any scarring that has already been caused by the infection.
For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID.
Prompt antibiotic treatment could prevent severe damage to the reproductive organs.

What should a patient do after being diagnosed with pelvic inflammatory disease?
A patient should abstain from sexual intercourse until she and her partner(s) have completed treatment.
condoms are also an option to prevent spread of infection.
Educating adolescent and young women about prevention of STDs, including abstinence, consistent use of barrier methods of protection, immunization and the importance of receiving periodic screening for STDs and HIV.

How can pelvic inflammatory disease be prevented?
Latex condoms may reduce the risk of PID by preventing STDs.
screening of women at risk for infection and treatment of infected women and their sex partners can help to minimize the risk of PID.
Screening of young sexually active women for chlamydia has been shown to decrease the incidence of PID.
REGULAR treatment and follow up .
What are the risk factors for developing pelvic inflammatory disease?
Risk factors for PID include factors associated with STD acquisition, such as younger age, having a new or multiple sex partners, having a sex partner who has other concurrent sex partners, and inconsistent use of condoms during sex. Other factors that have been associated with PID include a history of STDs or prior PID, and vaginal douching.

What is Laparoscopy ?
During a pelvic laparoscopy, your doctor uses an instrument called a laparoscope to examine your reproductive organs. A laparoscope is a long, thin tube with a high-intensity light and high-resolution camera.

Your doctor insers the laparoscope through an incision in your abdominal wall. The camera relays images that are projected onto a video monitor. Your reproductive organs can be examined without performing open surgery. Your doctor can also use a pelvic laparoscopy to obtain a biopsy and treat some pelvic conditions.

Pelvic laparoscopy is called a minimally invasive procedure because only small incisions are made. Minimally invasive procedures often have a shorter recovery period, less blood loss, and lower levels of post-surgical pain than open surgery.

WHAT IS THE ROLE OF LAPAROSCOPY IN PID?
PID can be diagnosed clinically or with several modalities like ultrasound, CT scan and MR imaging. However, the gold standard of diagnosis is still laparoscopy, When the diagnosis is remain unclear after other tests are done or when antibiotic treatment is not working; diagnostic is the definitive test- LAPAROSCOPY.

Nevertheless some specific roles of laparoscopy are irreplaceable by other modalities particularly for women in reproductive age, menopausal women, doubtful diagnosis and other special cases.

WHEN IS LAPAROSCOPY ADVISED?
Some indications for surgery are:

Failure to respond within 48 to 72 hours of medical management.
Need to drain or remove an abscess, such as a tubo-ovarian abscess.
Cut scar tissue (adhesions) that is causing pain.
CHRONIC LOWER abdominal pain.
Infertility due to tubal disease or unexplained.
Is laparoscopy the best to handle PID?
Laparoscopy offers the possibility to diagnose and manage PID more early, safely and probably cost-effectively. Effective management prevents complications associated with delayed treatment and often preserves the patient's fertility or even catastrophic.Laparoscopy also improve the primary recovery of acute PID patients.

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