Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) means the infection or inflammation of upper genital tract i.e. the ovary, the fallopian tubes and the uterus. Generally seen in young sexually active females.
Cause:
There are several natural barriers which resist the causative organisms to ascend from vagina upwards e.g. intact hymen, acidity in vagina. Most of the pelvic inflammatory disease are caused by sexually transmitted microorganism mainly Neisseria gonorrhoeae and Chlamydia trachomatis. Less frequently other organism can also cause it. Endogenous microorganism (i.e. which are found in vagina) are also often responsible for pelvic inflammatory disease as they can alter the vaginal flora and acidity which may facilitate ascending spread of infection. When a virgin girl presents with pelvic inflammatory disease it is usually tubercular in nature.
In India and other developing countries many times the pelvic inflammatory disease may be caused by improper hygiene during delivery and unhealthy septic abortion done by untrained dais. Even minor operative procedure like D & C, Hysterosalpingography (tubal patenty test), manual removal of placenta can cause pelvic inflammatory disease. IUCD may increase the chance of pelvic inflammatory disease.
Types: Acute pelvic inflammatory disease.
Symptoms:
- Acute pelvic inflammatory disease
- Acute pain, dull aching constant low abdominal pain, fever.
- Chronic Pelvic inflammatory disease
- Low backache, pain during intercourse, vaginal discharge.
- There may be same menstrual irregularity.
- Couple could also come with complaints of infertility.
Diagnosis:Diagnosis is normally based on proper history and examination of patient. Detailed investigations e.g. pelvic ultrasound, blood counts, cervical and vaginal swab culture can pin point exact cause of infection. In few cases CT and MRI can be done.
Treatment: Depends on the underlying disease.
Medical: Antibiotic and pain killer can help initial cases, commonly used are like Doxycycline, erthromycin, cephalosporins
Minimal invasive surgery: It is required when the disease is spread inside and invading tubes and ovaries to form an abscess. Ultrasound guided aspiration or laparoscopic intervention may be required.
Prevention against Pelvic Inflammatory Disease:
- Hospital and hygienic delivery is ideal.
- Avoid septic abortion - Abortions / MTP to be performed in proper hygienic conditions and by trained person.
- Barrier method i.e. condom, prevent sexually transmitted diseases. Oral contraceptive pills especially minipills are also effective.
- In suspected cases IUCD should be avoided. Any vaginal infection should be treated prior to insertion of IUCD.
- Even female condom (Femshield) which covers cervix (uterine mouth) and entire vagina is highly effective to prevent infection.
- Early treatment with antibiotics in suspected cases.
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