What is Pelvic Inflammatory Disease (PID)?

Pelvic inflammatory disease is the inflammatory disorders involving the upper genital tracts in women. The infection ascends upwards from the cervix to cause inflammation of the uterus, fallopian tubes, ovaries and the pelvic region in women. It can lead to complications like formation of tubo-ovarian abscesses and pelvic peritonitis.

What causes Pelvic Inflammatory Disease?

PID is caused by bacterial infection ascending up the upper genital tract in women. It can be caused by sexually transmitted diseases as well as non-sexually transmitted diseases.

Sexually transmitted bacteria causing PID are Chlamydia Trachomatis, Neisseria Gonorrhoea , Mycoplasma Hominis, Mycoplasma Genitalium and Ureaplasma Urealyticum.

Non-sexually transmitted bacteria causing PID are streptococci, Gram-negative rods, Gardnerella Vaginalis and anaerobic bacteria.

Diagnostic Tests for Pelvic Inflammatory Disease

Diagnosis is made based on clinical symptoms, clinical findings and diagnostic tests.

Clinical findings that suggest PID include fever greater than 38 centigrade Celsius, abdomen tenderness on palpation, uterus, cervical or adnexal tenderness during vaginal examination and presence of abnormal mucopurulent cervical or vaginal discharge.

Specimens from the genitalia tract can be sent for antigen detection tests, culture and NAAT tests. If tested positive for Gonorrhoea or Chlamydia infection, elevated ESR/CRP levels, presence of white blood cells on microscopy of vaginal secretions, pelvic abscess detected on ultrasound; all these findings highly suggest PID.

The most specific tests for diagnosis of PID include:

1.Laparascopic findings of PID features
2.Transvaginal ultrasound/MRI which show thickened fluid filled fallopian tubes, tubal-ovarian complexes and free pelvic fluid.
3.Endometrial biopsy with histological findings consistent with endometritis.

Treatment of Pelvic Inflammatory Disease

Patients with PID require adequate rest and also analgesics to relieve the pain. Patients with Intra-Uterine Contraceptive Device (IUCD) should have it removed as it could be the source of infection.

Pregnant woman and HIV women with PID should be hospitalized for close monitoring and should be treated with intravenous form of antibiotics. 

Empirical antibiotics given for low risk patients should be broad spectrum to cover the following bacteria: Gram-negative bacteria, Chlamydia Trachomatis,Gonorrhoea, anaerobes, genitalia mycoplasma and Group B Streptococcus.

Patients can be treated with the following antibiotics regime:

1.Single dose Intra-muscular ceftriaxone 500 mg PLUS
Oral Doxycycline 100 mg twice daily for 2 weeks PLUS
Oral Metronidazole 400 mg twice daily for 2 weeks.

2.Oral ofloxacin 400 mg twice daily for 2 weeks PLUS
Oral metronidazole 400 mg twice daily for 2 weeks PLUS
Oral Levofloxacin 500 mg once daily for 2 weeks.

Intravenous antibiotics instead of oral antibiotics should be considered if:

1.Patient do not respond to oral antibiotics after 3 days
2.Immunosupressed and pregnant patients
3.Patients with very severe clinical symptoms and signs
4.Patients with pelvic abscess suspected.

Intravenous antibiotics should be continued another 24 hours after clinical improvement. After discharge, patients need to continue with oral antibiotics for at least 2 weeks.

Follow up

Patients with PID should be monitored and follow up with the relevant specialists. Male partners of women who have PID due to chlamydia/gonorrhoeamay not have any symptoms. Partners of affected patients in the preceding 60 days before onset of symptoms should be screened, examined and tested. 

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