INTRODUCTION
In the US, ~800,000 women are diagnosed with pelvic inflammatory disease (PID) each year. However, the US Centers for Disease Control and Prevention (CDC) estimates that more than one million women experience an episode of PID each year taking into account missed cases of PID. The rates of PID are concerning given the serious potential complication of PID, including tubal infertility, ectopic pregnancy, and chronic pelvic pain (CPP). Missed and/or improperly or inadequately treated cases of PID increase the risk of complications of PID. Not only does the severity of these complications highlight the seriousness of the disorder, but also young women indicated that they are willing to give up 12 years of their life to prevent PID and its associated complication, as reported in a recent health economics study using time tradeoffs to assess patient utilities for the health states associated with PID in a general population sample.
Overview
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries. Pelvic inflammatory disease (PID) is a common cause of disease in young women and is usually secondary to a sexually transmitted infection. The diagnosis is based on clinical history and examination, but is inaccurate and leads to over diagnosis of the condition. Despite this, empirical antibiotic treatment based on a clinical assessment is still recommended because failure to treat PID can result in infertility, ectopic pregnancy and chronic pelvic pain in up to 40% of women. It is important to exclude an ectopic pregnancy before starting treatment for PID for women which are pregnant. Screening and treatment of male partners is important to prevent re-infection which is associated with an increased risk of long-term.
What Causes Pelvic Inflammatory Disease (PID)?
Normally, the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to numerous bacterias, the cervix itself becomes infected and is less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract.
Diagnosis
Pelvic inflammatory disease can be very difficult to diagnose. The symptoms of PID are very non-specific. In other words, they can be caused by a number of different conditions. Therefore, it can take time for doctors to recognize that a woman is dealing with PID rather than a different type of infection or condition. The best method for diagnosis of Pelvic inflammatory disease is a laparoscopic examination. With this type of examination, a small camera is used to look for inflammation and scarring inside the abdominal cavity. However, it can be difficult to justify this type of examination when symptoms are mild. PID can also be diagnosed by symptoms, but that type of diagnosis is much less accurate. When looking for symptoms of PID, doctors are specifically looking for pain in the cervix, uterus, or Fallopian tubes which often causes pain around the pelvic. Doctors may also use trans- vaginal ultrasound to look for inflammation. Once doctors suspect PID, they also need to look for the underlying infection. Therefore PID diagnosis also usually involves comprehensive screening for bacterial STDs and also a fungi infection. However, sometimes standard methods of STD screening will not detect infections present in the uterus, Fallopian tubes, or the rest of the upper reproductive tract.
Subclinical PID is defined as inflammation of the upper reproductive tract in the absence of signs and symptoms of acute PID. subclinical patients with PID are asymptomatic, According to the CDC 2015 Sexually Transmitted Diseases Treatment Guidelines, any young sexually active woman or woman at risk for STIs with unexplained lower abdominal or pelvic pain and at least one of the following clinical criteria noted on pelvic examination should receive presumptive treatment for PID: cervical motion tenderness, uterine tenderness, and adnexal tenderness.
Diagnosis can also be made based on signs and symptoms, a pelvic exam, an analysis of vaginal discharge and cervical cultures, or urine tests.
During the pelvic exam, your doctor will first check your pelvic region for signs and symptoms of PID. Your doctor might then use cotton swabs to take samples from your vagina and cervix. The samples will be analyzed at a lab to determine the organism that's causing the infection.
How Can Pelvic Inflammatory Disease Be Prevented?
Randomized, controlled trials suggest that preventing chlamydial infection reduces the incidence of PID. In addition, anyone who has had sexual contact with a woman with PID in the 60 days preceding the onset of her symptoms should be treated empirically for C. trachomatis and N. gonorrhoeae. CDC guidelines recommend that even if a patient last had sexual intercourse more than 60 days before symptom onset or diagnosis, the most recent sex partner should be treated. Regardless of whether a womans sex partners were treated, women diagnosed with chlamydial or gonococcal infection should follow up with repeat testing within 3-6 months. These women have a high rate of re-infection within 6 months of treatment.
Adolescents are more likely to have recurrent PID than adults are and so may require a different approach to make a follow-up, improved education, routine screening, diagnosis, and empirical treatment of these infections should reduce the incidence and prevalence of these processes and the development of long-term complications. Education should concentrate on strategies to prevent PID and STIs, including reducing the number of sexual partners, avoiding unsafe sexual practices, and routinely using appropriate barrier protection. Adolescents, being at an increased risk for PID, should be advised to delay the onset of sexual intercourse until age 16 years or older. Women with PID should be counseled to abstain from sexual activity or use barrier protection strictly and appropriately until their symptoms and those of their partner have fully abated and they have completed their entire treatment regimen.
Management
If it's diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics. These can be prescribed by your GP or a doctor at a sexual health clinic. But left untreated, it can lead to more serious long-term complications. Some of these treatments are listed below;
Antibiotics
Treatment with antibiotics needs to be started quickly, before the results of the swabs are available. PID is usually caused by a variety of different bacteria, even in cases where chlamydia, gonorrhoea or mycoplasma genitalium. This means you'll be given a mixture of antibiotics to cover the most likely infections, some of the antibiotics commonly prescribed to treat PID include: Ofloxacin, Metronidazole, Ceftriaxone, Doxycycline, Moxifloxacin. Tell your doctor if you think you may be pregnant before starting antibiotic treatment, as some antibiotics should be avoided during pregnancy. You'll usually have to take the antibiotic tablets for 14 days, sometimes beginning with a single antibiotic injection, its very important to complete the entire course of antibiotics, even if you're feeling better, to help ensure the infection is properly cleared. In particularly severe cases of PID, you may have to be admitted to hospital to receive antibiotics through a drip in your arm (intravenously). If you have pain around your pelvis or tummy, you can take painkillers such as paracetamol or ibuprofen while you're being treated with antibiotics.
Follow-up
In some cases, you may be advised to have a follow-up appointment of 3 days after starting treatment so your doctor can check if the antibiotics are working. If the antibiotics seem to be working, you may have another follow-up appointment at the end of the course to check if treatment has been successful. If your symptoms haven't started to improve within 3 days, you may be advised to attend hospital for further tests and treatment. If you have an intrauterine device (IUD) fitted, you may be advised to have it removed if your symptoms haven't improved within a few days, as it may be the cause of the infection.
Treating sexual partners
Any sexual partners you have been with in the 6 months before your symptoms started should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified. PID can occur in long-term relationships where neither partner has had sex with anyone else. It's more likely to return if both partners aren't treated at the same time. You should avoid having sex until both you and your partner have completed the course of treatment. If you haven't had a sexual partner in the previous 6 months, your most recent partner should be tested and treated. Your doctor or sexual health clinic can help you contact your previous partners.
Complications
Repeated episodes of PID Some women experience repeated episodes of PID. This is known as recurrent pelvic inflammatory disease. The condition can return if the initial infection isn't entirely cleared. This is often because the course of antibiotics wasn't completed or because a sexual partner wasn't tested and treated. If an episode of
PID damages the womb or fallopian tubes, it can become easier for bacteria to infect these areas in the future, making it more likely that you'll develop the condition again. Repeated episodes of PID are associated with an increased risk of infertility.
Abscesses
PID can sometimes cause collections of infected fluid called abscesses to develop, most commonly in the fallopian tubes and ovaries. Abscesses may be treated with antibiotics, but sometimes laparoscopic surgery (keyhole surgery) may be needed to drain the fluid away. The fluid can also sometimes be drained using a needle that's guided into place using an ultrasound scan.
Long-term pelvic pain
Some women with Pelvic inflammatory develop long-term (chronic) pain around their pelvis and lower abdomen, which can be difficult to live with and lead to further problems, such as depression and difficulty sleeping (insomnia). If you develop chronic pelvic pain, you may be given painkillers to help control your symptoms. Tests to determine the cause may be carried out. If painkillers don't control your pain, you may be referred to a pain management team or a specialist pelvic pain clinic.
Ectopic pregnancy
An ectopic pregnancy is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes. If PID infects the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through. If a fertilized egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe and life-threatening internal bleeding. If you're diagnosed with an ectopic pregnancy, you may be given medication to stop the egg growing or have surgery to remove it.
Infertility
As well as increasing your risk of having an ectopic pregnancy, scarring or abscesses in the fallopian tubes can make it difficult for you to get pregnant if eggs can't pass easily into the womb. It's estimated about 1 in 10 women with PID become infertile as a result of the condition, with the highest risk for women who delayed treatment or had repeated episodes of PID.
But a long-term study in the US showed that women who'd been successfully treated for PID had the same pregnancy rates as the rest of the population. Blocked or damaged fallopian tubes can sometimes be treated with surgery. If this isn't possible and you want to have children, you may want to consider an assisted conception technique, such as IVF. IVF involves surgically removing eggs from a woman's ovaries and fertilizing them with sperm in a laboratory, before planting the fertilized eggs into the woman's womb.
Remember Health Is Wealth.
Written by: Isikadi Precious, RN
