Pelvic inflammatory disease
Pelvic inflammatory disease: Excerpt from Professional Guide to Diseases (Eighth Edition)
Pelvic inflammatory disease (PID) is any acute, subacute, recurrent, or chronic infection of the oviducts and ovaries, with adjacent tissue involvement. It includes inflammation of the fallopian tubes (salpingitis) and ovaries (oophoritis), which can extend to the connective tissue lying between the broad ligaments (parametritis). Early diagnosis and treatment prevent damage to the reproductive system. Untreated PID may cause infertility and may lead to potentially fatal septicemia and shock.
Causes and incidence
PID can result from infection with aerobic or anaerobic organisms. The organisms Neisseria gonorrhoeae and Chlamydia trachomatis are the most common cause because they most readily penetrate the bacteriostatic barrier of cervical mucus.
Normally, cervical secretions have a protective and defensive function. Therefore, conditions or procedures that alter or destroy cervical mucus impair this bacteriostatic mechanism and allow bacteria present in the cervix or vagina to ascend into the uterine cavity; such procedures include conization or cauterization of the cervix.
Uterine infection can also follow the transfer of contaminated cervical mucus into the endometrial cavity by instrumentation. Consequently, PID can follow insertion of an intrauterine device, use of a biopsy curet or an irrigation catheter, or tubal insufflation. Other predisposing factors include abortion, pelvic surgery, and infection during or after pregnancy.
Bacteria may also enter the uterine cavity through the bloodstream or from drainage from a chronically infected fallopian tube, a pelvic abscess, a ruptured appendix, diverticulitis of the sigmoid colon, or other infectious foci.
Common bacteria found in cervical mucus are staphylococci, streptococci, diphtheroids, chlamydiae, and coliforms, including Pseudomonas and Escherichia coli. Uterine infection can result from any one or several of these organisms or may follow the multiplication of normally nonpathogenic bacteria in an altered endometrial environment. Bacterial multiplication is most common during parturition because the endometrium is atrophic, quiescent, and not stimulated by estrogen.
In the United States, nearly 1 million people develop PID each year; many cases go undiagnosed. About 1 in 8 active adolescents will develop PID before age 21.
Signs and symptoms
Clinical features of PID vary with the affected area but generally include a profuse, purulent vaginal discharge, sometimes accompanied by low-grade fever and malaise (particularly if gonorrhea is the cause). The patient experiences lower abdomen pain; movement of the cervix or palpation of the adnexa may be extremely painful. Frequent, painful urination is also commonly reported.
Diagnosis
Diagnostic tests generally include:
❑ Gram stain of secretions from the endocervix or cul-de-sac. Culture and sensitivity testing aids selection of the appropriate antibiotic. Urethral and rectal secretions may also be cultured.
❑ Ultrasonography to identify an adnexal or uterine mass.
In addition, patient history is significant. In general, PID is associated with recent sexual intercourse, insertion of an intrauterine device, childbirth, abortion, or a sexually transmitted disease.
Treatment
To prevent progression of PID, antibiotic therapy begins immediately after culture specimens are obtained. Such therapy can be re-evaluated as soon as laboratory results are available (usually after 24 to 48 hours). Infection may become chronic if treated inadequately.
Development of a pelvic abscess necessitates adequate drainage. A ruptured abscess is life-threatening. If this complication develops, the patient may need a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Alternatively, laparoscopic drainage with preservation of the ovaries and uterus may be done.
Concurrent treatment of sexual partners and condom use throughout the course of treatment are necessary.
Special considerations
❑ After establishing that the patient has no drug allergies, administer antibiotics and analgesics, as ordered.
❑ Check for fever. If it persists, carefully monitor fluid intake and output for signs of dehydration.
❑ Watch for abdominal rigidity and distention, possible signs of developing peritonitis. Provide frequent perineal care if vaginal drainage occurs.
❑ To prevent a recurrence, explain the nature and seriousness of PID, and encourage the patient to comply with the treatment regimen.
❑ Stress the need for the patient’s sexual partner to be examined and, if necessary, treated for infection.
❑ Because PID may cause painful intercourse, advise the patient to consult with her physician about sexual activity.
❑ To prevent infection after minor gynecologic procedures, such as dilatation and curettage, tell the patient to immediately report any fever, increased vaginal discharge, or pain. After such procedures, instruct her to avoid douching and intercourse for at least 7 days.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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