What is PID?
-Its an ascending infection of the female upper genital tract- above the cervix
Which maybe acute or chronic.
- The spectrum of disease include:
- Endometritis
- Salpingitis
- Oophoritis
- Tubo-ovarian Complex/abscess
- local or generalised peritonitis
What are the Risk Factors of PID?
- Early sexual debut
- High numbers of sexual partners.
- Low parity.
- Presence of Bacterial Vaginosis
- Previous PID/STI
- IUD can increase the risk of PID in the short term.
- Age <25 y/o
- Concomitant STI
What is acute PID?
- Can also be called acute salpino-oophoritis.
- Acute PID affects women of reproductive age
- It is sexually transmitted
What is Chronic PID?
-Could be an end result of acute PID
-Adhesions and fibrosis from the acute episode can lead to:
severe distortion of pelvic anatomy
resulting in a frozen pelvis.
-Diagnosis is usually made at surgery
What is the pathogenesis of PID?
- Primary Invasion of bacteria
- Infection starts in the lower genital tract
- Where primary invaders are introduced
- Via sexual intercourse
- Primary invasion may also manifest shortly after menstruation
- After insertion of an IUCD
- After uterine curettage
- Hysterescopy
- Hysterosalpingogram
Name the 3 most common primary invaders of PID:
1.Chlamydia Trachomatis
{azithromycin}
- Neisseria Gonorrhoea
{ceftriaxone}
- Anaerobes
* Mycoplasma Hominis
* Gardnerella Vaginalis
What happens in secondary invasion?
- Secondary invasion occurs usually by normal vaginal flora (anaerobes and gram-negative organisms)
- The disease causes progressive inflammation, swelling and hyperaemia (an excess of blood in the vessels supplying an organ) of the fallopian tubes.
- The inflammation impairs the mobility of the tubes
- and causes tubal adhesions to surrounding structures
-In more severe cases the tubal ostia become occluded
-Pelvic peritonitis occurs
-And a pyosalpinx/
Tubo-ovarian complex is formed
-If the complex ruptures into the peritoneal cavity, it causes generalised peritonitis.
