Pelvic Inflammatory Disease

Infection of the upper female genital tract

Includes

  • endometritis (infection of the uterine cavity),

  • salpingitis (infection of the fallopian tubes),

  • mucopurulent cervicitis (infection of the cervix),

  • oophoritis (infection of the ovaries).

Complications

  • infertility

  • ectopic pregnancy

  • chronic pelvic pain

Epidemiology

  • commonly <35

  • rare before menarche, after menopause, in pregnancy

  • risk factors

    • multiple sexual partners

    • previous PID

    • use of an IUD

    • the presence of bacterial vaginosis / STD

    • nulliparity

    • recent instrumentation of the uterus (eg, abortion)

  • Oral contraceptives reduce the risk of developing acute PID.

Infectious agents

 Symptoms and Signs

  • Major criteria

    • lower abdominal tenderness

    • unilateral or bilateral adnexal tenderness

    • cervical motion tenderness

  • fever

  • vaginal discharge

  • abnormal uterine bleeding

  • frequently during or after menses

  • cervicitis

    • cervix appears red

    • bleeds easily

    • yellow-green mucopurulent discharge (>10 PMN per HPF)

  • acute salpingitis

    • onset usually shortly after menses

    • lower abdominal pain - progressively more severe

    • guarding

    • rebound tenderness

    • cervical motion tenderness

    • nausea and vomiting

  • Chronic salpingitis

    • chronic pelvic pain

    • menstrual irregularities

    • infertility

  •  N. gonorrhoeae is usually more acute and typical than C. trachomatis

Complications

  • Tubo-ovarian abscess

    • 15% women

    • requires percutaneous drainage

  • Pyosalpinx

  • Hydrosalpinx

    • mucosal destruction leads to infertility

    • generally asymptomatic

    • pelvic pressure

    • chronic pelvic pain

    • dyspareunia.

  • Fitz-Hugh-Curtis syndrome

    • right upper quadrant pain in association with acute salpingitis (indicates perihepatitis)

Investigations

  • FBC

  • Cervical swab for gonorrhoea / chlamydia

  • pregnancy test

  • pelvic USS

  • laparoscopy

Differential diagnosis

Treatment