Our biggest problems as human ironically are so small we can't see them with our naked eyes, microorganisms! In both obstetric and gynecologic cases, we are always concerned about septic complications. Some cases get so serious and result in life long complications like subfertility.
The genital tract has it's own microorganisms that are always there and are beneficial, but when a different type of bacteria gets introduced into the tract, then, we could have some problems. Let me paint you a quick picture, imagine a tube greased with jello at the top, now put your finger into the tube, now you've spread the jello into the tube! That's what happens most times in one of our headaches as gynecologists, pelvic inflammatory disease(PID).
What is PID?
It is a syndrome associated with the ascending spread of microorganisms from the vagina and or cervix to the sterile reproductive structures, the uterus, the fallopian tubes and surrounding structures.
It is a polymicrobial infection commonly sexually transmitted.
Who's at Risk?
Younger ladies are more involved as it is seen majorly in ladies under 25 years. Basically, in a ladies in their sexually active phase.
Ladies in unstable relationships are on this table as promiscuity increases the likelihood. Unsafe sexual practices, such as unprotected sexual intercourse exposes one to PID.
I used the jello on tube to explain the ascension of the microorganisms, this is typical in a case of intrauterine device use. If an intrauterine device is inserted while a person has a vaginal infection, the device would "push" the organisms along with it, into the sterile uterine cavity.
Low socioeconomic status has been implicated as personal hygiene is generally worse in this population.
What causes PID?
PID is polymicrobial, this simply means several microorganisms have been implicated in its pathogenesis. Some of the more commonly implicated organisms are Nisseria gonorrhea and Clamydia trachomatis.
Some viruses, such as Echovirus and Coxsackie have been implicated, though unclear.
How does the infection spread?
I mentioned how PID is an ascending infection, that is the most common mode of spread but not the only. Let's quickly check out the others...
Other modes of ascension include procedures like hysterosalpingogram, dilation and curettage. Also, in an event of a miscarriage or even after childbirth.
Other less common modes of spread are hematogenous, as in a case of pelvic tuberculosis and spread from contiguous structures as in a case of acute appendicitis.
What are the symptoms?
I'm not going to bore y'all with the pathology, so let's go to the clinical features.
Major features involved seen are;
• Abdominal pain
• Cervical motion tenderness
• Adnexal tenderness
Others include;
• Abnormal vaginal bleeding
• Abnormal vaginal discharge
• Post coital bleeding (after sex)
• Deep dyspareunia (painful intercourse)
• Fever >38°C
• Nausea and vomiting
• Urinary symptoms (frequency, urgency and incontinence)
It should be noted that for every 1 patient with symptoms, 2 are asymptomatic.
How is PID diagnosed?
PID is diagnosed clinically, with the three cardinal signs;
• Abdominal tenderness
• Adnexal tenderness and
• Cervical motion tenderness
Though diagnosis is clinical, some investigations are essential and aid in treatment. Investigations include;
• Endocervical swabs
• High vaginal swabs
• Screen for STDs
• Pregnancy test(to eliminate ectopic pregnancy)
• Ultrasound scan
A surgical approach may be indicated and a laparoscopy is done. Laparoscopy is the gold standard for the diagnosis of PID.
How is PID treated?
The treatment may be medical or surgical, but its usually medical.
An antibiotics combination of ceftriaxone and doxycycline for 14 days usually does the trick. Metronidazole is added in some cases.
Surgery is indicated only when peritoneal complications arise. A laparotomy is done.
PID secondary to STI should be well managed by extending therapy to male partners to avoid reoccurrence.
How can PID be prevented?
Better sexual behavior and hygiene.
Use of barrier contraceptives (condom).
Screening before intrauterine device insertion.
Reduced incidence of unsafe abortions.
Conclusion
PID is a discomforting disease and has quite a deleterious effect on the patient and long term complications such as subfertility. With better sexual practices and hygiene, if can be easily prevented.