Pelvic inflammatory disease (PID) is a common yet complicated condition which affects the upper genital tract, including the Fallopian tubes, ovaries and the ligaments surrounding the upper pelvic area. When the inflammation specifically affects the Fallopian tubes it is sometimes called salpingitis or endosalpingitis.

It is thought to be caused mainly by infection with Chlamydia and gonorrhoea, although other pathogens such as mycoplasma, tuberculosis, actinomycosis, CMV and herpes, or about 40 other sources of infection may sometimes also be to blame. Some of these other bacteria are normally found in the vagina but are allowed to grow abnormally by changes in the bacterial balance of the vagina. The uterus is normally protected from bacteria in the vagina by a plug of mucus and the endocervical canal; infection with Chlamydia or gonorrhoea is thought to damage the canal, allowing these and other organisms to penetrate into the uterus. Hormonal changes during the menstrual cycle may affect the protective mucus, which is also released during the menses.

PID does not immediately result from infection; the causative organisms can produce low-level infection for weeks or even months before PID occurs. Without correct diagnosis and treatment, PID can become a recurrent, chronic or life-threatening health problem. With prompt treatment, it can be completely curable.

Symptoms

Symptoms of PID include acute or dull lower abdominal pain that lasts for more than a day or two; an abnormal discharge from the vagina; fever; vomiting; lower back pain or swelling; and fatigue. Untreated PID can also cause bleeding between periods, excessively painful periods, trouble walking due to the pain and other disabling conditions. In some case untreated PID can be life-threatening.

Diagnosis

The gold standard for diagnosing PID is laparoscopy a type of exploratory surgery involving a small incision in the abdomen below the navel, which allows a tube-like lighted instrument (a laparoscope) to be inserted into the pelvic cavity for visual inspection. Non-invasive scans may provide information about the size of a woman's reproductive organs and may indicate any unusual growths (cysts or abscesses) which could be a sign of acute PID. The presence of sexually transmitted or infections can be detected by looking for the organisms in cultures or smear tests.

Treatment

Treatment is with combinations of antibiotics which are effective against a range of sexually transmitted infections and bacteria. Suggested regimes include metronidazole plus doxycycline, erythromycin, or co-amoxiclav alone. In severe cases gentamicin plus a tetracycline may be required.

References

Hare J. Pelvic inflammatory disease: current approaches and ideas. International Journal of STD and AIDS 1: 393-400, 1990.

Johal B et al. Management of pelvic inflammatory disease. International Journal of STD and AIDS 1: 401-404, 1990.

Kahn JG et al. Diagnosing pelvic inflammatory disease: a comprehensive analysis and considerations for developing a new model. Journal of the American Medical Association 266(18): 2594-2604, 1991.

Peterson HV et al. Pelvic inflammatory disease: key treatment issues and options. Journal of the American Medical Association 266(18): 2605-2611, 1991.

Rice PA et al. Pathogenesis of pelvic inflammatory disease: what are the questions? Journal of the American Medical Association 266(18): 2587-2593, 1991.