Pelvic inflammatory disease definition:
Upper genital tract inflammation characterized by salpingitis with any of the following
may be accompanied: endometritis, oophoritis and/or peritonitis.
Pelvic inflammatory disease risk factors:
1. Sexual activity:
P.I.D is sexually transmitted. It is more common in women with multiple partners
than those with single partner, and rare in catholic nuns.
2. Infected male partner:
Gonococcal or chlamydial infected male partners are responsible.
3. Intrauterine contraceptive device :
IUD users are at higher risk, (No more considered).
4.Age:
Teenagers are more affected than older women. (Causes?!!)
5. Previous history of PID:
Women who had PID are at more risk to develop salpingitis.
Pelvic inflammatory disease protective factors:
1. Pregnancy:
Pregnancy is a protective factor against PID (Causes?!!), also women with acute
salpingitis do not get pregnant.
2. Hormonal contraceptives:
They protect against PID by its effect on cervical mucous and reduced amount
menstrual bleeding.
3. Mechanical contraceptives:
Impair access of microorganisms and so reduce the risk of developing PID
4. Tubal sterilization:
PID after tubal ligation is very rare.
5. Serum antibody titres:
High antibody titres against chlamydia antigens provide protection against
chlamydia infection.
Pelvic inflammatory disease causative organisms:
– Chlamydia trachomatis.
– Neisseria gonorrhoeae.
– Mycoplasma hominis.
– Actinomyces israelii.
– Other aerobic and anaerobic organism may be superadded.
Pelvic inflammatory disease types:
– Acute PID.
– Chronic PID;
– Chronic specific e.g. Tuberculosis.
– Chronic non-specific.
Staging of acute pelvic inflammatory disease:
– Stage I: Acute endometritis – salpingitis without peritonitis.
– Stage II: Acute salpingitis with peritonitis.
– Stage III: Acute salpingitis with superimposed tubal occlusion or tuboovarian complex.
– Stage IV: Ruptured tubo-ovarian abscess.
– Stage V: Respiratory complications , e.g. tuberculosis.
The Diagnostic criteria of Acute Salpingitis:
Differential Diagnosis of PID:
– Ovarian cyst with complication e.g. torsion.
– Ectopic pregnancy.
– Septic abortion.
– Endometriosis.
– Acute appendicitis.
– Urinary tract infection.
– Inflammatory bowel disease e.g. ulcerative colitis.
– No specific pathology.
Pelvic inflammatory disease investigations:
1. Ultrasound:
It is of value in diagnosis of pelvic collection and to exclude abortion.
2. Laparoscopy:
Indicated whenever there is doubt about the diagnosis.
Contraindicated if large adnexal masses or adhesions are existing.
3. Other investigations (of little value):
* Culdocentesis:
– To obtain peritoneal exudate for culture.
– Disadvantages;
– Higher incidence of contamination by microorganisms of the vagina.
– Rupture of a pelvic abscess on needle aspiration.
* Microbiological investigations:
– Gram stain for endocervical smear.
– Culture for chlamydia trachomatis and Neisseria gonorrhoeae.
– WBCs count. (Not specific).
– Immunological investigations for chlamydia.
* Serum CRP: (also of non- specific value).
* Cancer antigen -125: Elevated in PID but not specific also.
Pelvic inflammatory disease treatment:
♦♦♦ Some conditions may be treated ambulatory, in others patients have to be hospitalized.
♦♦♦ Treatment differs according to stage of the disease.
Stage I & stage II
♦♦♦ According to CDC (Centers for Disease Control and prevention) guidelines 2006;
Oral therapy (mild cases);
– R1 or R2 may be tried;
Parenteral therapy (sever cases);
♦♦♦ Have to be administered for 2- 4 days after fever subsides.
♦♦♦ Patient is discharged and continues oral therapy of Doxycycline 100 mg twice daily.
♦♦♦ Regimen A or regimen B is suggested as antibiotic therapy beside general measures.
♦♦♦ General measures.
– Bed rest:
Fowler position facilitates the collection of free pus in Douglas pouch.
– Drug therapy:
– Fluids; as patient may be dehydrated due to fever and vomiting.
– Analgesia: as opiates, and NSAIDs (e.g. Ibuprofen)
– Removal of IUCD:
An IUCD may be the cause of infection and should be removed especially in severe cases.
Stage III & stage IV Tubo- ovarian (Pelvic) Abscess
♦ The male partner is treated with the same ambulatory treatment of his wife.
Complications of PID;
1. Recurrent attacks of PID:
– Once the tubes have been damaged, become more liable of bacterial colonization.
2. Tubo- ovarian abscess
– It complicates about 35 % of patients admitted.
3. Chronic pain:
– Chronic pelvic or abdominal pain.
4. Infertility:
– Related to degree of tubal damage, Chlamydia causes more tubal damage.
5. Ectopic pregnancy:
– Due to destructed cilia and narrowing of lumen by inflammatory edema.
6. Preterm labour:
– Patients with previous PID may suffer from preterm labour in subsequent pregnancies.
7. Fitz- Hugh- Curtis syndrome
– Spread of infection from the tubes to the liver capsule, causing chronic right hypochondrialpain and tenderness.
– The infection spreads transperitonealy and may be hematogenous or by lymphatics
Inflammation of the liver capsule is followed by adhesions with the parietal peritoneum.
– It has to be differentiated from cholecystitis, pyelonephritis, and appendicitis.
Pelvic inflammatory disease videos:
Pelvic Inflammatory Disease video
Dr. Oller explains PID. What is it? diagnosis? treatment? and the all important follow up.
(PID) video
Pelvic Inflammatory Disease – CRASH! Medical Review Series video
(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
Pelvic Inflammatory Disease Part I video
This is an e-lecture on PID by Prof. Ajit Virkud. The first of two part series discusses the epidemiology and pathophysiology of PID. It is meant for undergraduate and postgraduate students of obstetrics & gynecology. 1:39 Definition 1:51 Prevalence 2:25 High Risk factors 7:20 Protective Factors 8:28 Pathology 10:57 Mode of Spread 12:06 Types of PID 12.50 Hydrosalpinx 15:32 Long-term Complications 17:53 Disseminated PID 18:38 Differential Diagnosis
Pelvic Inflammatory Disease Part II video
This is an e-lecture on PID by Prof. Ajit Virkud. The second of two part series discusses the diagnosis and treatment of PID. It is meant for undergraduate and postgraduate students of obstetrics & gynecology.
Pelvic inflammatory disease PPT (power point presentations):
PID PPT