Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive system, including the uterus, fallopian tubes, ovaries, and the inside of the pelvis. It is a significant health issue due to its potential to cause severe complications, including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

Signs and Symptoms

PID can range from asymptomatic to severe. When symptoms are present, they may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Complications such as endometritis, salpingitis, tubo-ovarian abscess, pelvic peritonitis, periappendicitis, and perihepatitis can also occur.

Drawing showing the usual sites of infection in pelvic inflammatory disease

Illustration of pelvic inflammatory disease

Complications

PID can cause scarring inside the reproductive system, leading to chronic pelvic pain, infertility, and ectopic pregnancy, which is the leading cause of pregnancy-related deaths in adult females. The infection can also spread to the peritoneum, causing inflammation and scar tissue formation on the liver's external surface, known as Fitz-Hugh–Curtis syndrome.

Fitz-Hugh–Curtis syndrome with perihepatic adhesions following a chlamydia infection

Cause

PID is commonly caused by the bacteria Chlamydia trachomatis and Neisseria gonorrhoeae, although it can also result from other untreated infections like bacterial vaginosis. The condition is often polymicrobial, involving multiple bacterial species. The anatomical structure of the female reproductive tract allows pathogens to ascend from the vagina to the pelvic cavity, increasing the risk of infection.

Diagnosis

Diagnosis is primarily based on symptoms, such as lower abdominal pain and vaginal discharge. Definitive diagnosis may require laparoscopy, which can visualise adhesions and abscesses. Other useful diagnostic methods include ultrasound, CT, MRI, and various blood tests to identify infections.

Mucopurulent cervical discharge seen on a cotton bud

Micrograph of salpingitis – a component of pelvic inflammatory disease. H&E stain.

Prevention

Preventive measures include regular testing for sexually transmitted infections (STIs), using condoms, limiting the number of sexual partners, and seeking medical attention if symptoms of PID or STIs are present. Hormonal contraceptives can also reduce the risk by thickening the cervical mucus.

Treatment

Treatment generally involves antibiotics, often started without waiting for confirmation due to the risk of complications from delayed treatment. Common regimens include cefoxitin or cefotetan plus doxycycline, and clindamycin plus gentamicin. Hospitalisation might be necessary for severe cases or complications. Treating sexual partners is also very important to prevent reinfection.

Prognosis

Early diagnosis and immediate treatment are essential to reduce the risk of long-term complications. Even with treatment, some damage may be irreversible, leading to infertility or chronic pain. Therefore, prompt medical attention is very important.

Epidemiology

Globally, PID affects about 1.5 percent of young women annually. In the United States, it is estimated to affect around one million people each year, causing over 100,000 women to become infertile annually. Rates are highest among teenagers and first-time mothers.

Population at Risk

The population at risk includes sexually active individuals under 25 with intact female reproductive organs, those with multiple sexual partners, inconsistent condom use, and a history of untreated STIs. PID is rarely seen in females who have had a hysterectomy.

In conclusion, PID is a significant health concern requiring awareness and prompt medical intervention to prevent severe long-term consequences.

Self-assessment MCQs (single best answer)

What is Pelvic Inflammatory Disease (PID)?

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Which of the following is NOT a common symptom of PID?

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What bacteria are commonly responsible for causing PID?
[mcq 374.11] _Escherichia coli_ and _Staphylococcus aureus_ [wrong 374.11] Incorrect. These bacteria are not typically associated with PID. [end feedback 374.11]
[mcq 374.12] _Chlamydia trachomatis_ and _Neisseria gonorrhoeae_ [right 374.12] Correct! These bacteria are the most common causes of PID. [end feedback 374.12]
[mcq 374.13] _Mycobacterium tuberculosis_ and _Legionella pneumophila_ [wrong 374.13] No, these bacteria are not associated with PID. [end feedback 374.13]
[mcq 374.14] _Helicobacter pylori_ and _Salmonella enterica_ [wrong 374.14] Incorrect. These bacteria are not responsible for PID. [end feedback 374.14]
[mcq 374.15] _Listeria monocytogenes_ and _Bacillus anthracis_ [wrong 374.15] No, these bacteria are not associated with PID. [end feedback 374.15]

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Which diagnostic method involves direct visualisation of adhesions and abscesses in PID?
[mcq 374.16] Ultrasound [wrong 374.16] Incorrect. Ultrasound can help diagnose PID but does not provide direct visualisation of adhesions and abscesses. [end feedback 374.16]
[mcq 374.17] MRI [wrong 374.17] No, MRI is not typically used for direct visualisation in PID. [end feedback 374.17]
[mcq 374.18] CT scan [wrong 374.18] Incorrect. CT scans are not primarily used for direct visualisation of adhesions and abscesses in PID. [end feedback 374.18]
[mcq 374.19] Laparoscopy [right 374.19] Correct! Laparoscopy allows for direct visualisation of adhesions and abscesses in PID. [end feedback 374.19]
[mcq 374.20] Blood tests [wrong 374.20] No, blood tests cannot provide direct visualisation of adhesions and abscesses. [end feedback 374.20]

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What is a significant complication of PID that can lead to pregnancy-related deaths?
[mcq 374.21] Ectopic pregnancy [right 374.21] Correct! Ectopic pregnancy is a serious complication of PID that can be life-threatening. [end feedback 374.21]
[mcq 374.22] Appendicitis [wrong 374.22] Incorrect. Appendicitis is not a complication of PID. [end feedback 374.22]
[mcq 374.23] Uterine fibroids [wrong 374.23] No, uterine fibroids are not a complication of PID. [end feedback 374.23]
[mcq 374.24] Ovarian cysts [wrong 374.24] Incorrect. Ovarian cysts are not a significant complication of PID. [end feedback 374.24]
[mcq 374.25] Endometriosis [wrong 374.25] No, endometriosis is not a complication of PID. [end feedback 374.25]

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Which syndrome involves inflammation and scar tissue formation on the liver's external surface due to PID?
[mcq 374.26] Gilbert's syndrome [wrong 374.26] Incorrect. Gilbert's syndrome is a genetic liver disorder unrelated to PID. [end feedback 374.26]
[mcq 374.27] Fitz-Hugh–Curtis syndrome [right 374.27] Correct! Fitz-Hugh–Curtis syndrome is a rare complication of PID involving the liver. [end feedback 374.27]
[mcq 374.28] Turner syndrome [wrong 374.28] No, Turner syndrome is a chromosomal disorder unrelated to PID. [end feedback 374.28]
[mcq 374.29] Marfan syndrome [wrong 374.29] Incorrect. Marfan syndrome is a genetic disorder affecting connective tissue, not related to PID. [end feedback 374.29]
[mcq 374.30] Cushing's syndrome [wrong 374.30] No, Cushing's syndrome is an endocrine disorder unrelated to PID. [end feedback 374.30]

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Which preventive measure is NOT recommended for reducing the risk of PID?
[mcq 374.31] Regular testing for STIs [wrong 374.31] Incorrect. Regular testing for STIs is highly recommended to prevent PID. [end feedback 374.31]
[mcq 374.32] Using condoms [wrong 374.32] No, using condoms is an effective preventive measure against PID. [end feedback 374.32]
[mcq 374.33] Limiting the number of sexual partners [wrong 374.33] Incorrect. Limiting the number of sexual partners reduces the risk of PID. [end feedback 374.33]
[mcq 374.34] Ignoring symptoms of STIs [right 374.34] Correct! Ignoring symptoms of STIs is not recommended and increases the risk of PID. [end feedback 374.34]
[mcq 374.35] Hormonal contraceptives [wrong 374.35] Incorrect. Hormonal contraceptives are sometimes used to reduce the risk of PID. [end feedback 374.35]

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What is the primary treatment for PID?
[mcq 374.36] Surgery [wrong 374.36] Incorrect. Surgery is not the primary treatment for PID. [end feedback 374.36]
[mcq 374.37] Radiation therapy [wrong 374.37] No, radiation therapy is not used to treat PID. [end feedback 374.37]
[mcq 374.38] Antibiotics [right 374.38] Correct! Antibiotics are the main treatment for PID. [end feedback 374.38]
[mcq 374.39] Chemotherapy [wrong 374.39] Incorrect. Chemotherapy is not a treatment for PID. [end feedback 374.39]
[mcq 374.40] Physical therapy [wrong 374.40] No, physical therapy is not used to treat PID. [end feedback 374.40]

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What percentage of young women globally are affected by PID annually?
[mcq 374.41] 1.5% [right 374.41] Correct! Approximately 1.5% of young women globally are affected by PID each year. [end feedback 374.41]
[mcq 374.42] 5% [wrong 374.42] No, the correct percentage is lower. [end feedback 374.42]
[mcq 374.43] 10% [wrong 374.43] Incorrect. The actual percentage is lower. [end feedback 374.43]
[mcq 374.44] 15% [wrong 374.44] No, the correct percentage is lower. [end feedback 374.44]
[mcq 374.45] 20% [wrong 374.45] Incorrect. The actual percentage is lower. [end feedback 374.45]

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Which group is at the highest risk for developing PID?
[mcq 374.46] Postmenopausal women [wrong 374.46] Incorrect. Postmenopausal women are generally at a lower risk for PID. [end feedback 374.46]
[mcq 374.47] Women who have had a hysterectomy [wrong 374.47] No, women who have had a hysterectomy are not at high risk for PID. [end feedback 374.47]
[mcq 374.48] Sexually active individuals under 25 with multiple sexual partners [right 374.48] Correct! This group is at the highest risk for developing PID. [end feedback 374.48]
[mcq 374.49] Women who are not sexually active [wrong 374.49] Incorrect. This group is at a lower risk for PID. [end feedback 374.49]
[mcq 374.50] Individuals with chronic respiratory conditions [wrong 374.50] No, chronic respiratory conditions do not increase the risk of PID. [end feedback 374.50]

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