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Pelvic Inflammatory Disease (PID) - Coggle Diagram
Pelvic Inflammatory Disease (PID)
Pathogenesis
PID is an acute inflammatory process caused by infection. This disease process can affect organ(s) of the upper genital track, including the uterus, fallopian tubes, and ovaries
The predominant cause for infection in PID are sexually transmitted diseases, chlamydia and gonorrhea
These infections typically start in the vagina and migrate to the upper genital tract due to inadequate defense mechanisms. Microorganisms that are introduced through the vagina have the ability to disrupt the normal flora, which makes it easier for the pathogens to invade the upper genital tract via the cervix
PID can cause permanent damage by altering the epithelium of the upper genital tract. Additionally, infection activates the inflammatory response, which can lead to edema and even obstruction or necrosis of the upper genital tract
Bacteria from gonorrhea travel to the fallopian tubes and release toxic substances causing inflammation and damage
Bacteria from chlamydia travel to tubal cells where they replicate and cause the cell membrane to rupture, which results in irreversible scaring
These bacteria can further spread into the abdominal cavity by openings of the Fallopian tubes
PID can also progress by lymphatic drainage with parametric spread of infection, sexual intercourse, and retrograde menstruation
PID can be classified by either acute or chronic
Acute PID is typically short term and complications include peritonitis and bacteremia, which can potentially lead to endocarditis, meningitis, and infectious arthritis
Chronic PID is long term and generally results from untreated acute PID. Chronic PID complications include infertility, tubal obstruction, ectopic pregnancy, pelvic pain, and intestinal obstructions.
Incidence/Prevalence
The CDC reports a nationwide prevalence of self-reported PID diagnosis of 2.5 million cases among sexually active women ages 18-44
10% of untreated chlamydia infections progress to PID
During 2007-2016 the number of doctors visits for PID among women aged 15-44 decreased by 38.3% from 146,000 to 90,000
Data from 2013-2014 shows equal prevalence of STI’s among non-Hispanic black women and non-Hispanic white women, however, prevalence of PID is 2.2 times greater in non-Hispanic black women than non-Hispanic white women
Risk Factors
Infection by a previous STI that was not treated: If not treated, STI's will travel and infect the upper genital tract and cause PID
Multiple sex partners: Increases the risk of STD's linked to PID
Previous PID: Once you've had PID, bacteria that are normally harmless may be more likely to infect your reproductive organs
Sexual activity before age 25: The cervix is not fully matured, increasing the susceptibility to the STD's linked to PID
Use of douches: Can push bacteria into the reproductive organs and cause PID
Use of IUD birth control: Insertion of IUD can introduce bacteria into the reproductive organs and cause PID
Abortions: Procedures that open the cervix can introduce bacteria into the reproductive organs and cause PID
Puerperal infections: Occurs when bacteria infect the uterus and surrounding areas after a woman gives birth. This bacteria can potentially cause PID
Genetic factors: Female gender between the ages of 15-24
Diagnostics
There is no one test that can diagnose PID. Instead, diagnoses are based on findings from the patient's medical history, signs and symptoms, pelvic exam, blood and urine tests, and ultrasounds. Additional testing to diagnose PID include laparoscopy and endometrial biopsy only if the diagnosis is unclear after the original findings. Treatment of PID is the same for all ages.
Medical history: Sexual habits, history of STI's, and method of birth control
Signs and symptoms: Any signs or symptoms that deviate from normal, even if they're mild
Pelvic exam: Check pelvic region for tenderness and swelling. Obtain fluid samples from vagina and cervix using cotton swabs. Fluid samples will be tested for gonorrhea, chlamydia, and other signs of infection
Blood and urine tests: Tests for pregnancy, HIV, and other STI's. Measures white blood cell count to determine if infection or inflammation is present
Ultrasound: creates images of the reproductive organs
Laparoscopy: View pelvic organs by inserting an instrument through an incision in the abdomen
Endometrial biopsy: Obtains sample of endometrial tissue by inserting a tube into the uterus. The tissue obtained is tested for signs of infection and inflammation
Clinical Manifestations
Clinical manifestations of PID can very from sudden, severe symptoms to no symptoms at all. Symptoms are more likely to occur during or after menstruation. Symptoms of PID may worsen with walking, jumping, or intercourse. Clinical manifestations of PID are the same for all ages.
Pain in lower abdomen and pelvis: PID can damage the epithelium lining of the reproductive tract, causing pain in the lower abdomen and pelvis area
Heavy discharge with unpleasant odor: Discharge is the body's mechanism to cleaning and protecting the reproductive tract. Increased discharge occurs with infection
Irregular bleeding between periods: PID can progress into the uterus and alter menstruation, causing irregular bleeding
Pain during sex: PID can damage the epithelium lining of the vagina, causing pain during intercourse
Fever and chills: PID is an infection of reproductive organs. The cardinal signs of any infection are fever and chills
Painful urination: Bacteria that causes PID can also cause urinary tract infections and cause pain during urination
Treatments
Immediate treatment with medication can eliminate the infection that causes PID, however, there is often irreversible scarring and damage to the reproductive tract caused by PID
Antibiotics: Multiple antibiotics have been found to work against PID. Several types of antibiotics are often prescribed together to combat PID. Antibiotics are typically prescribed for 2 weeks, however, symptom relief should occur within 3 days of treatment. Patients are directed to finish the dose of antibiotics even if symptoms subside before then
Treatment for your partner: Sexual partners should be examined and tested to prevent reinfection with an STI
Temporary abstinence: Abstain from sexual intercourse until treatment is completed and symptoms have resolved
Common medications prescribed for the treatment of PID: Ceftriaxone, Doxycycline, Metronidazole, and Cefoxitin - Antibiotics used to treat bacterial infections
Ceftriaxone is a long-acting third-generation drug given once a day for the treatment of most infections. It can be given both IV or IM. The drug is highly protein bound and is metabolized in the intestine after biliary excretion. Ceftriaxone should not be given to neonates or patients with liver dysfunction
Doxycycline is a semisynthetic tetracycline antibiotic useful in treating Gram-negative bacteria including chlamydia and gonorrhea. It is available in both oral and injectable forms
Cefoxitin is a parenteral second-generation cephalosporin that treats Gram-negative bacteria better than first-generation drugs. Cefoxitin is available as an IV antibiotic
Metronidazole is an antimicrobial drug of the class nitroimidazole useful in treating gynecologic infections including chlamydia and gonorrhea. Metronidazole is available in oral and injectable forms.
PID treatment is most commonly outpatient, however, severe cases of PID may require hospitalization
References
Brunham, R., Gottlieb, S., & Paavonen, J. (2015). Pelvic inflammatory disease. The New England Journal of Medicine, 372(21), 2039-2048.
Center for Disease Control and Prevention. STDs in women and infants. Retrieved from
https://www.cdc.gov/std/stats18/womenandinf.htm#pid
on November 13, 2020.
Haggerty, C., Totten, P., & Tang, G. (2016). Identification of novel microbes associated with pelvic inflammatory disease and infertility. BMJ Journals, 92(6), 176-191.
Mayo Clinic. Pelvic inflammatory disease (PID). Retrieved from
https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/diagnosis-treatment/drc-20352600
on November 13, 2020.
Huether, S. E., McCance, K. L., & Brashers, V. L. (????).
Understanding pathophysiology
(7th ed.). St. Louis, Missouri: Elsevier.