Pelvic Inflammatory Disease (PID)
From Encyclopedia of Sex and Sexuality
The term pelvic inflammatory disease (PID) describes pelvic infections, specifically those of the fallopian tubes, ovaries, and uterus. More commonly it results from an ascending infection of pathogenic bacteria from the lower genital tract. It is estimated that in developed countries, 20 out of 100 women between fifteen and twenty-four years of age acquire PID each year. PID accounts for 25 percent of all admissions to gynecological services.
The major risk factors for PID are having multiple sexual partners, low socioeconomic status, previous episodes of PID, using an intrauterine contraceptive device (IUD), and young age. On the other hand several factors are known to provide some protection against PID:
- Pregnancy, especially after eight to ten weeks of gestation, protects from ascending infection and PID. After this stage PID is very uncommon.
- Women over forty-five years of age rarely develop PID.
- Using a condom as a contraceptive may protect against the spread of venereal diseases in general and have a special implication in preventing PID.
- Oral contraceptive pills offer some protection against ascending infections because of their negative influence on the receptivity of the cervical mucus.
Several sexually transmitted mircroorgisms such as Neisseria gonorrhea (gonococcus) and Chlamydia trachomatis are responsible for most PID infections. If a woman is culture-positive for gonococcus, her male partner has a positive urethral culture about 86 percent of the time. However, only half of these men will have any symptoms. The clinical picture of gonococcal PID is lower abdominal pain, beginning several days after sexual intercourse, accompanied by fever and vaginal discharge.
In the industrialized nations, Chlamydia trachomatis may be cultured from the cervix of 5 to 15 percent of asymptomatic women of reproductive age. About one-fourth of women who are cervical culture-positive for gonococcus are also culture-positive for chlamydia. The clinical picture of PID associated with chlamydia is less severe and sometimes asymptomatic. However, both organisms may result in late complications of tubal and pelvic adhesions that may impair future fertility in 20 to 30 percent of the patients.
Other pathogens have been cultured from the fallopian tubes of patients with PID. These included mycoplasma, pneumococci, campylobacter, tuberculosis, and anaerobic bacteria.
The inflammatory process in PID usually begins in the cervical epithelium as cervicitis, followed by uterine infection (endometritis), tubal infection (salpingitis), and eventually abdominal cavity infection (peritonitis). As the infection proceeds, fibrin deposits, along with other inflammatory cells, may damage the tubes, distorting their delicate structure. Both asymptomatic carriers of Neisseria gonorrhea (gonococcus) and Chlamydia trachomatisand symptomatic patients need antibiotic treatment to prevent complications. Penicillins, tetracycline, or sulfonamides are usually used, but other equally effective regimens are also available. laparoscopy is sometimes used to confirm the diagnosis and to obtain cultures in order to give specific antibiotic treatment according to the specific microorganism.
Complications of PID are:
- Tubal and ovarian abscesses: these may require laparotomy and often adnexectomy;
- Recurrence and reinfection: these may require hospitalization and intravenous antibiotic treatment;
- Intrauterine, tubal, peritubal, and pelvic adhesions: these may cause infertility;
- Tubal infections: sactosalpinx, hydrosalpinx, pyosalpinx, or hematosalpinx;
- Peritonitis: a general infection of the abdominal cavity;
- Douglas’s abscess: an abscess located between the uterus and the rectum.
Early recognition and treatment of PID will, in most cases, prevent complications. Using a condom and treatment for the sexual partners of a woman with PID will protect against the spread of venereal disease.
Early recognition and treatment of PID will, in most cases, prevent complications. Using a condom and treatment for the sexual partners of a woman with PID will protect against the spread of venereal disease.
