pelvic inflammatory disease

pelvic inflammatory disease
Field	Gynecology, Infectious disease (medical specialty)

pelvic inflammatory disease. It is an infection of the female upper reproductive tract, including the uterus, fallopian tubes, and ovaries. The condition is typically caused by ascending bacteria from the vagina and cervix. It represents a major public health concern due to its association with serious long-term reproductive complications.

Signs and symptoms

Common clinical presentations include lower abdominal pain and abnormal vaginal discharge. Patients may experience dyspareunia, irregular uterine bleeding, and dysuria. Severe cases can present with systemic signs such as fever and nausea, often mimicking other conditions like appendicitis or ectopic pregnancy. The Centers for Disease Control and Prevention notes that many infections are subtle or asymptomatic, which can delay seeking care from a gynecologist.

Causes and risk factors

The primary causative agents are sexually transmitted bacteria, most notably Neisseria gonorrhoeae and Chlamydia trachomatis. However, polymicrobial infections involving organisms like Mycoplasma genitalium and anaerobic vaginal flora are common. Key risk factors include a history of bacterial vaginosis, multiple sexual partners, and a prior episode of the condition. Procedures that breach the cervical barrier, such as dilation and curettage or hysteroscopy, can also facilitate ascending infection.

Diagnosis

Diagnosis is primarily clinical, based on patient history and a physical examination revealing cervical motion tenderness, uterine tenderness, or adnexal tenderness during a pelvic examination. Supportive criteria from the Centers for Disease Control and Prevention include documenting elevated erythrocyte sedimentation rate or C-reactive protein. Imaging with transvaginal ultrasonography may show thickened, fluid-filled fallopian tubes or tubo-ovarian abscess. Laparoscopic visualization, considered the diagnostic gold standard, is typically reserved for uncertain cases.

Treatment

Empiric antibiotic therapy is initiated promptly to cover likely pathogens, often using regimens recommended by the Centers for Disease Control and Prevention, such as ceftriaxone plus doxycycline, with or without metronidazole. Hospitalization for intravenous antibiotics is required for severe illness, pregnancy, or suspected tubo-ovarian abscess. Sexual partners from the preceding 60 days should be evaluated and treated to prevent reinfection, a practice emphasized by the World Health Organization.

Complications

Serious sequelae include chronic pelvic pain and infertility due to scarring and occlusion of the fallopian tubes. A significant risk is the development of ectopic pregnancy, as damaged tubes impede embryo transport. Recurrent episodes increase the likelihood of tubo-ovarian abscess formation, which may require drainage or surgical intervention by a gynecologic oncologist. Fitz-Hugh-Curtis syndrome, causing inflammation of the liver capsule, is a recognized extra-pelvic complication.

Prevention

Primary prevention focuses on reducing the transmission of Neisseria gonorrhoeae and Chlamydia trachomatis through barrier methods like condom use and sexual health education. Screening programs for asymptomatic women, as advocated by the United States Preventive Services Task Force, are crucial. Secondary prevention involves the prompt and appropriate treatment of bacterial vaginosis and lower genital tract infections to prevent ascending spread.

Category:Gynaecologic disorders Category:Infectious diseases