FEMALE GENITAL

INFLAMMATORY
DISEASE

By doc. O.Y. Stelmakh

Pelvic Inflammatory
Disease
A nonspecific term that most
commonly refers to inflammation
caused by infection in the upper
genital tract;
Often used synonymously with
the term acute salpingitis.

Infectious agents - STDs

PID Ascending infection

General classification of pelvic infections

by frequency of occurrence:

PID
Endometritis
Pelvic cellulitis
Oophoritis
tubo-ovarian abscess
Pelvic peritonitis

Clinical forms
Complicated
Endometritis
Acute purulent salpingitis
pelvioperitonitis

Uncomplicated
Purulent tubo-ovarian abscess
Other inflamed tumors of uterus
appendages

Clinical features
Acute
Subacute
Reccurent
Chronic

Incidence

Acute pelvic inflammatory disease occurs in 1%

to 2% of all young, sexually active women.
It is the most common serious infection of
women aged 16 to 25.
Approximately 85% of infections are
spontaneous in sexually active females.
The other 15% of infections develop following
procedures that break the cervical mucus
barrier, allowing the vaginal flora the opportunity
to colonize the upper genital tract.

The most common

etiologic agents in PID

These organisms initially cause lower genital tract

infections and then spread into the upper genital tract
trac
via the endometrium.
Many cases - polymicrobial in etiology. Pure gonococc
or chlamydial PID is possible.
The relative frequency of the various agents depends
somewhat on
the population tested,
the site cultured (i.e., cervix, endometrium, or
Fallopian tubes),
the sensitivity of the diagnostic tests performed.

The most common

etiologic agents in STD

There are at least 20 different STIs. They can be caused by viruses,

bacteria, and protozoa. Some of the most common STIs in the U.S. are:
Chlamydia.
Genital herpes.
Genital warts or human papillomavirus (HPV). Certain high-risk types of
HPV can cause cervical cancer in women.
Gonorrhea.
Hepatitis B.
Syphilis.
Trichomoniasis.
Human immunodeficiency virus (HIV), which causes AIDS. Having other
STIs, such as genital herpes, can increase your risk of HIV.
Other infections that may be sexually transmitted. These include hepatitis
A, cytomegalovirus, molluscum contagiosum, Mycoplasma genitalium,
hepatitis C, and possibly bacterial vaginosis.
Scabies and pubic lice, which can be spread by sexual contact.

Provocative agents

Menses
Intercourse
Abortion; miscarriage
Curettage of uterine cavity
Hysterosalpingography
In vitro fertilization

Intra-abdominal spread of gonorrhea

and other pathogenic bacteria
These infections are represented by
endometritis,
adnexal infection,
peritonitis.

Lymphatic spread of bacterial

infection
Typified by postpartum, postabortal, and some
IUD-related infections, results in extraperitoneal
parametrial cellulitis.

Hematogenous spread of
bacterial infection
In rare instances, certain diseases (eg, tuberculosis)
may gain access to pelvic structures by
hematogenous routes

Infectious agents - STDs

PID Ascending infection

PID: History and

Examination

Symptoms suggestive of PID include 3 or more signs:

Abdominal pain (usually bilateral and in the lower quadrants)
Onset of pain in association with menses,
Menometrorrhagia,
Vaginal discharge (purulent),
Dyspareunia,

Dysuria,
Fever, and/or chills,

Nausea or vomiting.

PID: History and

Examination
Painful palpation of the uterus
and appendages during
bimanual examination
Blood test WBC, ESR

PID: History and

Examination
Laparoscopy should be
performed at the 1st day
inpatient treatment after lab
examination in parallel with
antibiotic therapy

Laparoscopic findings Acute PID

N
Pyosalpinx

Pelvic inflammatory disease (PID) is a serious complication

of untreated STDs, especially chlamydia and gonorrhea. It
happens when bacteria spread to infect the uterus and
other female reproductive organs.

Trichomoniasis is caused by a parasite that spreads during

sexual contact. It can be cured with prescription drugs.

Diagnosis

Culdocentesis generally is productive

of reaction fluid (cloudy peritoneal
fluid) which, when stained, reveals
leukocytes with or without gonococci or
other organisms.
Ultrasound: incomplete septation of the
tubal wall (cogwheel sign) is a marker
for acute disease, and a thin wall
(beaded string) indicates chronic
disease.

U: Uterus
U
M

C: Cervix
F: Fallopian Tube

O: Normal Ovary
M: Inflamed Tubo-

Ovarian Mass

Note the hemorrhagic, edematous fallopian tubes, so

much so that the architecture of the right tube and ovary
is obscured. The surface of the tubo-ovarian mass is not
only red but also somewhat shaggy.

Look at how profoundly edematous all aspects of this

fallopian tube are. We are going to focus on the mucosal
folds, but the inflammatory features are present
throughout this specimen.

Complications of Acute
Salpingitis:
Pyosalpinx
In which one or both fallopian tubes are
filled with pus, may also be present.
The fluid may be sterile, but WBCs
predominate in it.

Chlamydia is a common STD that can lead to infertility if left

untreated. It clears up quickly with antibiotics. But it often
goes unnoticed because symptoms are vague or absent.
Chlamydia can also infect the rectum and throat.

Symptoms: Common symptoms are burning during urination

and discharge, but often there are no early symptoms.
Later, the infection may cause skin rashes or spread to the
joints and blood

Differential Diagnosis
Acute salpingitis must be differentiated
from acute appendicitis, ectopic
pregnancy, ruptured corpus luteum cyst
with hemorrhage, diverticulitis, infected
septic abortion, torsion of an adnexal
mass, degeneration of a leiomyoma,
endometriosis, acute urinary tract
infection, regional enteritis, and ulcerative
colitis.

Partners of patients
with
.
infection also need to be
treated

Recurrent or Chronic
Pelvic Infection

Recurrent pelvic inflammatory disease

begins as does primary disease, but
preexisting tubal tissue damage may
result in more severe infection.
Chronic pelvic infection implies the
presence of tissue changes in the
parametria, tubes, and ovaries.

Pelvic inflammatory disease (PID) is a serious complication

of untreated STDs, especially chlamydia and gonorrhea. It
happens when bacteria spread to infect the uterus and
other female reproductive organs.

Complications
Unruptured TOA may be complicated by rupture
with sepsis, reinfection at a later date, bowel
obstruction, infertility, and ectopic pregnancy.
Ruptured TOA is a surgical emergency and is
frequently complicated by septic shock, intraabdominal abscess (eg, subphrenic abscess),
and septic emboli with renal, lung, or brain
abscess.

Primary prevention
teaching adolescents safe sex
practices
promoting use of condoms and
chemical barrier methods.

Secondary prevention
Universal screening of women
at high risk for chlamydia and
gonorrhea;
Screening for active cervicitis;
Increasing use of sensitive
tests to diagnose lower genital
infection;
Treatment of sexual partners;
Education to prevent recurrent
infection.

There are three major

sequelae of PID:

ectopic pregnancies,
chronic pain,
infertility