PELVIC INFLAMMATORY

DISEASE

DEFINITION
Infection of the upper genital tract
Endometritis -infection of the uterine cavity
Salpingitis -infection of the tubes
Salpingo oophoritis -infection of tubes &
ovaries

Tubo-ovarian abscess
Pelvic peritonitis -infection of peritonium

epidemiology
Mainly affects women of child bearing
age
Commonly sexually acquired
Incidence 1-2% among sexually
active females

Organisms
Neisseria gonorrhoeae
Chlamydia trachomatis
commonest
E. coli, Group-B streptococcus &
staphylococcus
Anaerobic - Bacteroides
Mycoplasma hominis
Ureaplasma urealyticum

Mode of transmission
Ascending infection (Canalicular spread) COMMONEST
Ascend of gonococcal & chlamydial organisms by surface
extension from the lower genital tract through the cervical
canal by way of the endometrium to the fallopian tubes
Facilitated by the sexually transmitted vectors such as
sperms
Through uterine lymphatic & blood vessels across
parametrium
Gynecological procedures favouring ascend of infection
E.g. D&C, ERPC,IUI,Hysterosalpingography
Direct spread from contaminated structures in abdominal
cavity
E.g. Appendicitis

Risk factors

Multiple sexual partners

Past history of STI
Termination of pregnancy
IUCD insertion
Hystero salpingography
IVF procedure
Post partum endometritis
Recent new sexual partner

Diagnosis
Symptoms
Fever > 38 C
Abnormal vaginal discharge
Unexpected vaginal bleeding
Lower abdominal pain
Dyspareunia

 Signs
Lower abdominal tenderness
PV adnexal tenderness
cervical excitation
Pyrexia

Differential diagnosis

Ectopic pregnancy
Acute appendicitis
Urinary tract infection
Endometriosis
Ovarian cyst accident

Investigations

FBC
CRP
High vaginal swabs
Ultra sound scan Tubo - ovarian
abscess
Laparoscopy gold standard to
diagnose, but perform only in
doubtful cases or if tubo-ovarian
abscess is suspected

Management
Start antibiotics empirically until confirmation by
investigations
Admit if systemically unwell
Analgesics
Antibiotics
Broad spectrum covering aerobes and anaerobes
Eg: Neisseria - cephalosporins,penicillins
Chlamydia - doxycycline,azythromycin
anaerobic - metranidazole

Always treat the partner

Consider removing the IUCD

Complications
Tubo ovarian abcsess
Fitz Hugh Curtis syndrome
Peri hepatitis with PID
Fever right hypochondrial pain & tenderness

Chronic PID
Long term complication
Severe dysmenorrhoea
Recurrent episodes

 Chronic abdominal pain due to

adhesions
Subfertility - Tubal
Ectopic pregnancy