Pid PDF
Pid PDF
ABSTRACT : Pelvic inflammatory disease (PID) is the clinical syndrome represents inflammation of the
female,cervix,endometrium,fallopiantubes,pelvicstructure,salpingitis,pelvic peritonitis and tub ovarian
abscess.PID results from the spread of Neisseria gonorrhoeae, Chlamydial trachomatis, anaerobes,
Haemophilusinfluenza,G.vaginalis,Streptococcuspyogenes,gramnegative bacteria, and others. PID sequelae
include: ectopic pregnancy, infertility, tubo-ovarian abscess, dyspareunia, chronic pelvic pain, premature
rupture of membranes, preterm, delivery, and amnionitis. Most PID patients are treated as outpatients
hospitalization for very ill patients and those meet hospitalization criteria. CDC guidelines for antibiotic
treatment of PID patients are useful. Fluoroquinilones alone are no longer recommended due to emergence of
resistant N.gonorrhoeae.Screening for cervical chlamydia and gonorrhea infection can prevent PID.
I. INTRODUCTION
Pelvic inflammatory disease (PID) refers to clinical syndrome that represents a continuum of
inflammationfromthecervixtotheendometrium,fallopiantubes,andcontiguous,pelvicstructure:cervicitis,
endometritis,salpingitis,pelvic peritonitis,andtuboovarianabcess[I].Each year, approximately 1 million women in
the United States experience an episode of symptomatic PID.Many women with PID have minimal or no
symptoms [2].PID results from direct canalicular spread of microorganisms from the vagina or endocervix to the
endometrium and fallopian tube mucosa[3].Both Neisseria gonorrhoeae and C.trachomatis commonly cause
endocervitis.and clinical symptoms of acute PID develop in 10% to 40% of women with these infections who do
not receive adequate treatment [4].In addition to N.gonorrhoeae and C.trachomatis.a wide variety of bacteria
have been isolated from the upper genital tracts of women with acute symptomatic PID,including
anaerobes,gram negative rods, streptococci, and mycoplasma[5].Many of these are the same microorganisms
that are found in increased concentrations in the vaginas of women with bacterial vaginosis [6].Moreover,
approximately one of four women with presumed uncomplicated lower genital tract gonococcal or chlamydial
infection or bacterial vaginosis, or both, is found to have histological endometritis (subclinical PID) when
evaluated by endometrial biopsy[3].Uncommonly, respiratory pathogens including Haemophilus influenza and
Streptococcus pyogenes have also been isolated from the upper genital tracts of women with symptomatic
PID[7,8].Gold standards for PID diagnosis often impractical to achieve in the outpatient setting. Endometrial
biopsy showing changes consistent with PID,transvaginal ultrasound showing thickened fluid- filled tubes, and
laproscopic evidence of PID [9].Treatment regimens should be effective against gonorrhea chlamydial and
anaerobes[10].The paper reviews the risk factors, diagnosis and management of PID.
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Pelvic Inflammatory Disease: Current…
the result of acquired sexually transmitted pathogens and not the IUD itself [15].A unique role for Actinomyces
organisms in IUD associated PID has been suggested, but this relationship remains unclear. Although as many
as 4% to 8% of IUD users have Actinomyces-like organisms identified on Papanicolaou(Pap)smear, their
presence has not been equated with pelvic actinomycosis, nor has the risk of subsequent pelvic infection been
identified. In patients with cytology showing Actinomyces colonization [16].Bonacho and associates showed
that removal of the IUD was associated with resolution of colonization [17].
Clinical diagnosis and grading of PID have poor specificity. In fact, women with PID associated with
moderate to severe pelvic adhesions or tubal occlusion were found to have less tenderness on abdominopelvic
examination and therefore to appear less ill than women with limited or no adhesion [21].Diagnostic
laparoscopic should be considered in patients for empirical therapy has failed and in patients with a history of
recurrent PID and negative tests for Chlamydia, gonorrhea ,and bacterial vaginosis .Endometriosis is a common
alternative diagnosis in these women. Although rare, acute salpingitis can occur in the proximal stamp of
patients who have undergone surgical sterilization and in women in the first semester of pregnancy [19].
Treatment : Treatment consists of pelvic test and antibiotics. Antibiotic regimens must provide empirical
broad- spectrum coverage of likely pathogens, including N.gonorrhoeae, C.trachomatis, anaerobes, gram
negative facultative bacteria and streptococci. Several antimicrobial regimens have been effective in achieving
clinical and microbiologic cure in randomized clinical trials with short term follow up. The need to eradicate
anaerobes from women with PID has not been determined definitively. However, anaerobic bacteria associated
with bacterial vaginosis have been isolated from the upper reproductive tract of women with PID, and those
bacteria have been shown to cause tubal and epithelial destruction. One method of determining the
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Pelvic Inflammatory Disease: Current…
appropriateness of metronidazole therapy in women with PID is to determine the presence of concurrent
vaginosis [19] The fluroquinolone alone are no longer recommended in the treatment of PID due to emergence
of quinolone resistant N.gonorrhoeae. The Centers for Disease Control and Prevention have updated the
published antibiotic treatment guidelines for acute PID [24].If parental cephalosporin therapy is not feasible, use
of fluroquinolones (levofloxacin 500 mg PO once daily or ofloxacin 400 mg twice daily for 14 days)usually
with metronidazole(500 mg PO twice daily for 14 days) may be considered if the community prevalence and
individual risk is low. Tests for gonorrhea must be performed before instituting therapy. If the nucleic acid
amplification test result is positive for gonorrhea, a parental cephalosporin is recommended. If culture for
gonorrhea is positive, treatment should be based on results of antimicrobial susceptibility. If isolate is
quinolone- resistant N.gonorrhoeae or antimicrobial susceptibility cannot be assessed, parenteral cephalosporin
is recommended. Although information regarding other outpatient regimens is limited, amoxicillin/clavulanic
acid and doxycycline or azithromycin with metronidazole have demonstrated short-term clinical cure [25].
Optimal outpatient management includes a follow-up examination performed within 72 hours after
initiation of therapy. May patients may not return for this visit if they are symptomatically improved. Substantial
clinical improvement with lysis of fever. Reduction in direct or rebound abdominal tenderness and reduction in
pelvic organ tenderness with bimanual examination should be noted. If there is no response to therapy within 72
hours patient should be reevaluated and possibly hospitalized to confirm the diagnosis and for consideration of
parenteral antibiotic therapy if they are on an oral regimen. All male sex partners of women with acute PID
should be evaluated for sexually transmitted diseases, and those who had sexual contact with the patient during
60 days preceding the onset of symptoms in the patient should be empirically treated with regimens effective
against C.trachomatis and N.gonorrhoeae.In many circumstances the male sex partner tests positive for
chlamydia or gonorrhea,but the patient receiving the therapy is negative; such results shed light on the
pathogenesis of infection[26].
Tuboovarian abscess: Patients with suspected tuboovarian abscess should be hospitalized and given broad –
spectrum antimicrobial drugs that include adequate coverage for gram- negative anaerobes. Failure to respond to
medical therapy is suggested by lack of defervescence within 72 hours or an increase in size of mass.Eighty–
five percent of abscesses with a diameter of 4 to 6 cm respond to antibiotics alone, but only 40% of those 10 cm
or larger respond. Triple-agent therapy with ampicillin.clindamycin,and gentamycin would seem to be the
regimen of choice, although other combination regimens have been used effectively [27,28].Surgical
intervention for tuboovarian abscess that does not respond to antimicrobial therapy can be performed
laproscopically,percutaneously,or transvaginally or by laparotomy. A patient with a suspected leaking or
ruptured abscess should undergo immediate surgical exploration after rapid stabilization and institution of broad
spectrum antibiotics [29].
Genital tract tuberculosis :Genital tract tuberculosis most common in the developing countries. Usually
results from hematogenous spread from pulmonary infection, rarely from contiguous intraperitoneal disease or
direct sexual intercourse.Clinically, an indolent infection.Chief presentation is infertility and also vaginal
bleeding or chronic pelvicpain, Diagnosis by hysterosalpingogram may show characteristic changes, however
endodermal or fallopian tube histology, which demonstrates granulomas, positive acid-fast stains, or positive
culture of endometrial aspirates,isrequired.Therapy by antituberculousdrugs, and surgery if symptoms persists
[26].
thirds of women attempting pregnancy are unable to conceive. Other sequelae associated with PID include dyspareunia,
pelvic adhesions, and chronic pelvic pain[30].PID is also associated with premature rupture of membranes, preterm delivery,
and ammonites [31].Screening for cervical chlamydia infection can prevent PID[32].
V. CONCLUSION
PID represents inflammation of female cervix to the endometrium; fallopian tubes and contiguous pelvic structure.
Many cases are asymptomatic and go unrecognized or not diagnosed. Clinicians need to be aware of the implications of
unrecognized PID in clinical practice.
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