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Pelvic Inflammatory Disease

Pelvic inflammatory disease it is an infection of the upper genital tract in females mainly involving the uterus, fallopian tubes and ovaries. The causes

  1. sexual activity+++
  2. multiple sexual partners
  3. unhygienic sexual practices- non usage of condoms during sex
  4. invasive gynaecological procedures
  5. young age
  6. history of sexually transmitted infections

The two most common organisms responsible for PID are chlamydia trachomatis and Neisseria gonorrhoea

Clinical features

  • Pain abdomen
  • Pain during intercourse
  • Abnormal vaginal discharge which is foul smelling or Purulent
  • Pain or burning sensation while passing urine
  • Bleeding after intercourse
  • Menstrual irregularities
  • Fever nausea and vomiting
  • On examination uterus maybe tender or painful to palpate
    •

    Investigations include

  • urine routine analysis and culture
  • endocervical swabs for culture
  • STI screening
  • Urine pregnancy check
  • Transvaginal ultrasound scan

    • Complications

    Complications are usually seen when pelvic inflammatory disease is not treated appropriately or if the treatment is delayed.

    1. Tubo ovarian abscess- fallopian tube and the ovary develops pus within and are enlarged to form a mass.
    2. Infertility almost 10% of women with PID have fertility issues.
    3. Chronic pelvic pain which does not subside with painkillers.
    4. Fits Hug Curtis syndrome -patients typically develop right upper abdominal pain with adhesions around the liver.
    5. Ectopic pregnancy up to 30% of patients with ectopic pregnancy will develop it due to pelvic infections.
    6. Abnormal uterine bleeding resulting in menstrual irregularities.

    Treatment includes intravenous or oral antibiotics in appropriate dosages to be given for 5 to 14 days depending on the clinical presentation. adequate treatment is the key for the resolution.Very rarely patient may develop tubo ovarian abscess or adhesions which might require surgical intervention including laparoscopy where the adhesions are released and the tubo ovarian abscess is removed.