Pelvic Inflammatory Diseases

Definition

This occurs when there is ascending infection from the endocervix to the higher reproductive tract.

It is a recognized complication of chlamydia and less frequently of gonorrhoea.

The diagnosis of PID is usually made clinically

Symptoms typically include:

• Lower bilateral abdominal pain.
• Dyspareunia.
• Altered vaginal discharge.
• IMB.
• PCB.

Systemic Symptoms

• Lower abdominal
• Cervical motion tenderness
• Cervicitis. Testing for all STIs is required, as is exclusion of pregnancy

Treatment

Where PID is suspected empirical treatment should be started immediately, as delay increases the risk of complications.

Complications

• Endometritis
• Fallopian tube inflammation (salpingitis)
• Subfertility
• Ectopic pregnancy
• Chronic pelvic pain.
• Right upper quadrant pain due to perihepatitis (called Fitz-Hugh–Curtis syndrome).

Management of PID

Laparoscopy

• Laparoscopy in women with PID may reveal scarring and adhesion formation.
• Intrauterine device (IUD) should be removed.

Treatment Regimes

• Regimes should cover all common pathogens and are 2 weeks in duration
• They include a macrolide or tetracycline plus metronidazole with a parenteral third-generation cephalosporin at the start.
• Partners require screening and empirical treatment, usually with azithromycin.
• Women require clear information regarding possible sequelae from their infection.

Complications of PID

Fitz-Hugh–Curtis Syndrome

Fitz-Hugh–Curtis syndrome showing perihepatic adhesions (typical violin string appearance).

A Peri-tubal adhesions of the left Fallopian tube; B: Ectopic pregnancy within hydrosalpinx; C: Left Fallopian tube hydrosalpinx; D: Large hydrosalpinx of the left Fallopian tube with a smaller hydrosalpinx on the right side