Pelvic Inflammatory Disease
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Pelvic inflammatory disease is a condition involving the pelvic organs i.e. cervix (cervicitis), uterus (endometritis), salpinx (salpingitis) and ovaries (oophoritis).
Organisms that may be responsible for this disease are- Neisseria gonorrhoea and Chlamydia trachomatis. Endogenous aerobic bacteria such as E. coli, Klebsiella, Proteus and Streptococcus species and endogenous anaerobes such as Bacteroides, Peptostreptococcus and Peptococcus; Mycoplasma hominis and Actinomycetes isreali affect predominantly the vagina presenting as vaginal discharge but ascend through the cervical tract to cause Pelvic Inflammatory Disease (PID). PID is a disease of the young woman.
Some of the predisposing factors are:
- Sexual intercourse
- Induced abortion
- Dilatation and curettage or endometrial biopsy
- Intra-uterine device (IUD) insertion or use
- Hysterosalpingosramy
- Laparoscopy
- Radium insertion into the endometrial cavity.
Clinical Features Symptoms:
- Lower abdominal pain
- Copious purulent vaginal discharge may be present or absent
- High-grade fever is an indicator for admission
- Vomiting
- Nausea
- Painful sexual intercourse (dyspareunia)
Signs:
- Occasional diarrhoea
- Lower abdominal tenderness with rebound is an indicator for admission
- Adnexia tenderness
- Cervical excitation
Complications
- Peritonitis
- Tuba-ovarian abscess
- Hydrosalpinx
- Ectopic Pregnancy
- Chronic Pelvic Pain
- Infertility
- Mortality
Indications for immediate referral to gynaecology or surgery
- missed/overdue period
- recent delivery or abortion
- abdominal guarding or rebound tenderness
- abnormal vaginal bleeding
- abdominal mass
- temperature above 38 degrees Celsius