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[Music] Pelvic inflammatory disease refers to an ascending poly-microbial infection and inflammation of the female genital tract, which can include the cervix, uterus, fallopian tubes, ovaries, and the surrounding structures.
Comprehensive overview of Pelvic Inflammatory Disease (PID), covering causes, symptoms, diagnosis, complications, and treatment options.
Key Takeaways
- PID is a serious polymicrobial infection that can cause severe reproductive complications if untreated.
- Early clinical diagnosis and prompt antibiotic treatment are essential to preserve fertility and prevent complications.
- Sexually transmitted infections like Chlamydia and gonorrhea are major causes, highlighting the importance of STI prevention.
- Imaging and laparoscopy are valuable diagnostic tools, especially for complicated or unclear cases.
- Treatment of sexual partners and abstinence during therapy are vital to avoid reinfection.
What the video covers
- Pelvic inflammatory disease (PID) is an ascending polymicrobial infection affecting the female genital tract including cervix, uterus, fallopian tubes, and ovaries.
- Infections often start from the vagina and cervix, commonly caused by Chlamydia trachomatis, Neisseria gonorrhea, and other anaerobic bacteria.
- Severe PID can lead to life-threatening complications such as peritonitis and Fitz-Hugh-Curtis syndrome involving liver capsule inflammation.
- Symptoms vary but typically include lower abdominal pain, abnormal vaginal discharge, irregular uterine bleeding, fever, nausea, and dyspareunia.
- Complications include hydrosalpinx, tubo-ovarian abscess, infertility, and increased risk of ectopic pregnancy due to tubal scarring.
- Risk factors include age under 35, multiple sexual partners, unprotected sex, douching, and recent intrauterine procedures.
- Diagnosis is clinical with key signs like cervical motion tenderness (chandelier sign), uterine or adnexal tenderness, supported by lab tests and imaging.
- Laparoscopy is the gold standard for diagnosis but reserved for uncertain or non-responsive cases.
- Treatment involves early empirical antibiotics, with outpatient oral regimens or inpatient IV therapy for severe cases; abscesses may require drainage or surgery.
- Partner treatment and abstinence during therapy are critical to prevent reinfection.
Chapters
- 00:00Introduction to Pelvic Inflammatory Disease
- 00:52Severe Complications of PID
- 01:15Additional PID Complications
- 01:47Symptoms of PID
- 02:15Additional Symptoms and Fitz-Hugh-Curtis Syndrome
- 02:58Tubo-ovarian Abscess and Hydrosalpinx
- 03:24Causes and Risk Factors
- 04:12Clinical Diagnosis and Chandelier Sign
- 05:05Laboratory and Imaging Investigations
- 06:02Laparoscopy and Its Role
Full Transcript — Download SRT & Markdown
Speaker A
The pathophysiology involves infection from the vagina and cervix ascending into the upper genital tract. Often, this is facilitated by epithelial damage by organisms like Chlamydia trachomatis or Neisseria gonorrhea, which then facilitates other microorganisms to enter, such as anaerobes, Ureaplasma, Haemophilus, and enteric gram negatives. Bacterial vaginosis can also facilitate this ascent by disrupting the normal vaginal flora.
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In severe cases, inflammation may spread to the peritoneum, the inner membrane that lines the abdomen and pelvis, resulting in peritonitis, which can be life-threatening.
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It can also spread to involve the liver capsule, called perihepatitis, also known as Fitz-Hugh-Curtis syndrome, and this can lead to development of adhesions between the liver capsule and the abdominal wall, sometimes called violin string adhesions. Other complications
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like hydrosalpinx, meaning blockage of fluid in the fallopian tubes, and tubo-ovarian abscess can also develop.
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The signs and symptoms are variable depending on the organs involved, and also bear in mind that the severity of the inflammation may not correlate with the severity of symptoms.
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Typical symptoms of PID include lower abdominal or pelvic pain. This can be present particularly if the fallopian tubes are affected and is often bilateral but may be unilateral.
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Abnormal cervical or vaginal discharge. This may be mucopurulent discharge that is often yellow or green. Abnormal uterine bleeding, including irregular vaginal bleeding, especially postcoital or intermenstrual bleeding. Inflammation of the uterus, termed endometritis, can lead to the irregular bleeding.
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Fever is another common feature. Other features include nausea, vomiting, and malaise, and dyspareunia, meaning pain on intercourse, is also a common finding. In Fitz-Hugh-Curtis syndrome, there may be right upper quadrant pain, and episodes may become chronic and feature
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intermittent episodes of PID or pain. A tubo-ovarian abscess is a collection of pus within the adnexa, which can result in pain and fever as well as potentially peritonitis and sepsis. This tends to follow salpingitis, meaning inflammation of
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the fallopian tubes, in around 15% of cases, and there may be a mass on palpation.
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Hydrosalpinx tends to be asymptomatic but may present with chronic pelvic pain or pressure. Infertility is another potential complication of PID, experienced in around 20% of cases, as well as there being an increased risk of ectopic pregnancy following salpingitis due to adhesions and
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scarring of the tubules. PID is traditionally thought to be caused by sexually transmitted organisms such as Chlamydia trachomatis, believed to cause between 14 and 35% of cases, gonorrhea, and Mycoplasma genitalium, alongside various anaerobic and aerobic bacteria often associated with bacterial
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vaginosis, for example Gardnerella. Others, as mentioned, include Ureaplasma, Haemophilus, and enteric gram negatives. Risk factors include prior PID or presence of an STI or bacterial vaginosis.
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As such, risk factors for STI and bacterial vaginosis are also risk factors for PID, including age under 35, new or multiple sexual partners, unprotected intercourse, douching, and recent intrauterine instrumentation such as IUD insertion or abortion.
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The diagnosis is clinical and should be considered early in sexually active females of reproductive age, especially with risk factors present. The minimum diagnostic criteria on pelvic exam include one of three signs: cervical motion tenderness, also known as the
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chandelier sign, meaning pain on manipulation of the cervix, getting the chandelier sign name due to the severity of the pain causing an involuntary movement reaching upwards as if grabbing a chandelier.
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Another is uterine tenderness or adnexal tenderness, which was found to have a sensitivity of 96% but a low specificity at 4%. Lab investigations include pregnancy test to rule out an ectopic pregnancy, cervical swabs for nucleic acid amplification testing for Chlamydia and gonorrhea, a
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wet mount of vaginal secretions looking for polymorphonuclear vaginal cells indicating vaginal infection. Absence of these has a 94.5% negative predictive value.
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Bloods including full blood count, ESR, or CRP may also be done. Imaging studies such as transvaginal ultrasound or CT are indicated when an abscess or alternative pathology is suspected or if the pelvic exam is limited by pain.
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Laparoscopy remains the gold standard and can visualize pelvic structures directly, but it is mostly reserved for uncertain cases or in those cases with a lack of response to treatment.
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Treatment involves early initiation of empirical antibiotic therapy, as even days of treatment delay can result in impaired long-term fertility. In milder cases where hospitalization is not needed, there are multiple regimens possible. One first-line option includes ceftriaxone 500 mg intramuscularly
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as a single dose and doxycycline 100 mg orally twice a day for 14 days and metronidazole 400 mg orally twice a day for 14 days.
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For those requiring hospitalization, such as severe illness, or the inability to tolerate oral treatment, a suspected abscess, pregnancy, or poor clinical response, intravenous therapy can include a similar regimen of cephalosporin with doxycycline and metronidazole.
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Tubo-ovarian abscess may require drainage guided by ultrasound or CT in addition to antibiotic therapy. Surgical intervention is needed if rupture occurs or if the abscess fails to resolve.
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Treatment of sexual partners for gonorrhea and Chlamydia is essential to prevent reinfection, along with abstinence during therapy until confirmed cure.
Speaker A
Treatment of sexual partners for gonorrhea and chlamyia is essential to prevent reinfection along with abstinence during therapy until confirmed cure.
Topics:Pelvic Inflammatory DiseasePIDChlamydia trachomatisNeisseria gonorrheaFitz-Hugh-Curtis syndrometubo-ovarian abscesshydrosalpinxfemale reproductive infectionantibiotic treatmentsexual health
