PELVIC INFLAMMATORY DISEASE

Pelvic inflammatory disease ( PID )

It is a disease of upper genital tract. It is a spectrum of infection and inflammation of the upper genital tract,organs including endometrium, fallopian tube , ovaries , pelvic peritoneum and surrounding structures.

Risk factors :

- Menstruating teenagers

- Multiple sexual partner

- Previous history of PID 

- Area with prevalence of sexually transmitted disease

- Poly microbial infection after abortion , vaginal delivery

- latrogenic such as IUCD insertion, D & C , 

- tuberculosis

Causative organism :

✓ Neisseria gonorrhea, Chlamydia trachomatis, streptococcus, E.coli, staphylococcus etc

Clinical features :

- Lower abdominal pain

- Irregular and excessive vaginal bleeding

- Offensive vaginal discharge

- Fever, lasstitude., headache,

- Dyspareunia

- Nausea, vomiting

- Fever, tachycardia

- Abdominal examination reveals : distention, tenderness, rebound tenderness (+)

-:Vaginal examination reveals : purulent discharge, congested urethral meatus, congested cervix, cervical dilation test (+) 

Investigation :

- High vaginal swab culture

- Blood investigation ( tc, dc, hb, ESR )

- Stool & urine RME

- Uterine pregnancy test

- USG abdomen and pelvis

- Culdocentesis

- Laparoscopy

Differential diagnosis :

- Appendicitis

- Rupture ovarian cyst

- Endometriosis

- Urinary tract infection

Complication :

- Pelvic peritonitis

- Septicaemia

- Infertility

- Chronic pelvic pain

Treatment :

- Adequate rest 

- Sitz bath to reduce pain and discomfort

medical management :

- Amoxicillin / ampicillin 3mg orally

- Procaine penicillin

- Tetracycline 250 mg QID (7-14 days )

- Doxycycline 100 mg BID 7-14 days 

- Metronidazole 500mg TDS for 5 days.

Surgical management :

- Pelvic abscess- culdocentesis 

Prevention :

- Educating the patient to avoid infection

- Use condom

- Avoid multiple sexual partner

- Avoid use of IUCD 

- Maintain hygiene