What is this condition?
Pelvic inflammatory disease is any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the cervix, uterus, fallopian tubes, and ovaries, which can extend to the connective tissue lying between the broad ligaments.
Early diagnosis and treatment prevents damage to the reproductive system. Untreated, the disease may cause infertility and lead to potentially fatal blood infection, blood clots in the lungs, and shock.
What causes it?
Pelvic inflammatory disease can result from infection with bacteria, which invade the uterus when the defensive barrier formed by the cervical mucus is compromised. The breach may be caused by various procedures, such as insertion of an intrauterine device, biopsy instrument, or catheter. Other predisposing factors include abortion, pelvic surgery, and infection during or after pregnancy.
Bacteria may also enter the uterine cavity through the bloodstream or from drainage from a chronically infected fallopian tube, a pelvic abscess, a ruptured appendix, diverticulitis of the large intestine, or other infected areas.
The bacterium Neisseria gonorrhoeae most commonly causes pelvic inflammatory disease because it’s most able to cross the cervical mucus barrier. Other common bacteria found in cervical mucus are staphylococci, streptococci, diphtheroids, chlamydiae, and coliforms, including Escherichia coli and Pseudomonas. Uterine infection can result from one or more of these bacteria, or it may follow overgrowth of normally nonpathogenic bacteria in an altered endometrial environment, as occurs in childbirth.
What are the Symptoms of Pelvic Inflammatory Disease ?
Pelvic inflammatory disease symptoms vary with the affected area but generally include excessive pus discharge from the vagina, sometimes accompanied by low-grade fever and malaise (particularly if gonorrhea is the cause). The woman experiences lower abdominal pain, and movement of the cervix or palpation of the fallopian tubes or ovaries may be extremely painful.
How is it diagnosed?
Diagnostic tests generally include:
- Gram staining of secretions from the endocervix or cul-de-sac to identifY the bacterial agent; culture and sensitivity testing aids selection of the appropriate antibiotic. (Urethral and rectal secretions may also be cultured.)
- ultrasound to identifY a tubal or uterine mass (simple X-rays seldom identifY pelvic masses)
- culdocentesis (aspiration) to obtain peritoneal fluid or pus for culture and sensitivity testing.
- In addition, the woman’s history is significant. Pelvic inflammatory disease is typically associated with recent sexual intercourse, intrauterine device insertion, childbirth, or abortion.
How is it treated?
To prevent progression of pelvic inflammatory disease, antibiotic drug therapy begins immediately after culture specimens are obtained. Infection may become chronic if treated inadequately.
The guidelines of the Centers for Disease Control and Prevention for at-home treatment include a single dose of Mefoxin given along with Benemid, or a single dose of Rocephin. Each of these regimens is given with Vibramycin for 14 days.
The official guidelines for hospital treatment include Vibramycin alone or a combination of Cleocin and Garamycin.
Development of a pelvic abscess necessitates adequate drainage. A ruptured abscess is life-threatening. If this complication develops, the woman may need a total removal of her uterus, fallopian tubes, and ovaries.