Pelvic
Inflammatory Disease (PID) is an ascending infection of the female genital tract,
affecting the endometrium, fallopian tubes, ovaries, and surrounding pelvic structures.
Etiopathogenesis
- Ascending infection from the
cervix and vagina
- Sexually transmitted
infections (STIs) – Neisseria gonorrhoeae, Chlamydia trachomatis
- Anaerobic bacteria
(Bacteroides, Peptostreptococcus)
- Previous history of PID
- Intrauterine device (IUD)
use
- Multiple sexual partners
Risk Factors for PID
- Unprotected sexual
intercourse
- Multiple sexual partners
- History of STDs (e.g.,
gonorrhea, chlamydia)
- Use of intrauterine devices
(IUDs)
- Recent gynecological
procedures
Clinical Features of PID
- Lower abdominal pain
(Bilateral, dull in nature)
- Fever, malaise, and headache
- Abnormal vaginal discharge
(Purulent and copious)
- Dyspareunia (Painful
intercourse)
- Irregular excessive vaginal
bleeding
- Pain or discomfort in the
right hypochondrium (Fitz-Hugh-Curtis Syndrome - Perihepatitis)
Examination Findings
General Examination
- Fever (≥38°C)
- Lower abdominal tenderness
Pelvic Examination
- Purulent vaginal discharge
- Congested cervical os
- Bilateral adnexal tenderness
on bimanual examination
Laboratory Investigations
- Complete Blood Count (CBC) –
Raised WBC count
- Erythrocyte Sedimentation
Rate (ESR) – Elevated
- C-reactive protein (CRP) –
Elevated
- Gram Staining & Culture
of Vaginal/Cervical Discharge
- Endometrial Biopsy (If
chronic PID is suspected)
Imaging Studies
- Ultrasound (USG) – Detects
tubo-ovarian abscesses
- Laparoscopy – Gold standard
for diagnosis
Complications of PID
- Tubo-Ovarian Abscess
- Ectopic Pregnancy (Due to fallopian tube damage)
- Chronic Pelvic Pain
- Infertility
- Pelvic Peritonitis &
Sepsis
Management & Treatment
1. Outpatient Therapy
- Ceftriaxone 250 mg IM
(Single dose)
- Doxycycline 100 mg PO BID
for 14 days
- Metronidazole 500 mg PO BID
for 14 days
2. Inpatient Therapy (For Severe Cases)
- IV Ceftriaxone + IV
Metronidazole + IV Gentamicin
- Hospitalization for patients
with high fever, tubo-ovarian abscess, or failure of oral treatment
3. Surgical Management (For Severe Cases)
- Laparoscopic drainage of
tubo-ovarian abscess
- Total abdominal hysterectomy
with bilateral salpingo-oophorectomy (For chronic or recurrent PID cases)
Prevention of PID
- Safe sexual practices (Use
of condoms)
- Routine screening of
high-risk populations
- Early treatment of sexually
transmitted infections (STIs)
- Avoidance of multiple sexual
partners
