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Pelvic Inflammatory Disease Pid
 

Pelvic inflammatory disease Introduction

Pelvic inflammatory disease (PID) is a categorical name for numerous medical conditions of the female reproductive system. Upper genital infections, such as in the lining of the uterus (endometritis), the oviducts (salpingitis), the ovary (oophoritis), the uterine wall (myometritis) and the pelvic cavity, are all categorized under the general name, Pelvic inflammatory disease. Most long-term, PID problems result from the destruction of the fallopian tubes (the tubes that connect the uterus to the ovary) by infection. [1] Infections that cause Pelvic inflammatory disease are usually sexually transmitted, but can also be from the insertion of a foreign object such as an IUD for contraception.

Pelvic inflammatory disease is now estimated to affect over 1 million women a year in the U.S. alone. PID is the most common gynecological condition that results in the hospitalization of women of child-bearing age. Over one-fourth of these women will suffer serious long-term consequences and are at risk for reoccurrences. [2] It is now considered a leading cause of infertility and may be responsible for the increased risk of ectopic pregnancy (implantation and growth outside of the uterus). [3]

Acute pelvic inflammatory disease results from an ascending infection from the vagina to cervix. Bacteria colonize and infect the endometrium and fallopian tubes, and may travel towards the ovaries and other nearby soft tissues. It is often a disease of sexually active young women, and occurs spontaneously in roughly 85% of all cases. Other instances of PID are, largely, due to a disruption in the vaginal flora. The may result after surgery or insertion of an IUD. Infections will usually travel upwards into the more susceptible tissues, causing significant long-term damage. Risk factors may include an earlier start to sexual activity and having multiple sex partners.

Pelvic inflammatory disease Symptoms

It is extremely important to recognize the signs and symptoms of Pelvic inflammatory disease because of the potential for complications and damage.

  • The classic presentation is lower abdominal pain and tenderness during a routine examination, or motion of the cervix during a vaginal examination.
  • Some women will have discomfort during urination or intercourse, or both.
  • A vaginal discharge of pus or an excessive amount of normal discharge may be present, as well as irregular vaginal bleeding or swelling in the ovary region. [4]
  • Chills, present with a moderately high fever, nausea and vomiting, and a white blood cell count of over 20,000/ul is also common.

Pelvic inflammatory disease symptoms will often begin during or within one week of menstruation because the opening of the cervix is larger during this time of the month, making it easier for infections to ascend. A differential diagnosis of Pelvic inflammatory disease would include appendicitis, gallstones, kidney infections, ovarian cysts, and ectopic pregnancy.

Ideally, a laparoscopic examination would improve the diagnostic accuracy and allow the physician an opportunity to take laboratory samples. However, this procedure is expensive and not practical to use regularly.

  • Pelvic inflammatory disease is usually due to an infection with either Chlamydia or N. gonorrhea; other organisms such as Mycoplasma, Streptococcus and Ureaplasma urealyticum can also be present.
  • It is estimated that between 5-14% of screened women between the ages of 16-20 years old, and 3-12% of women 20-24 years old are infected with Chlamydia. [5]
  • Current research suggests that over 1/3 - 1/2 of cases of Pelvic inflammatory disease are due to either Chlamydia or N. gonorrhea. [6]
  • Education and prevention of sexually transmitted disease is imperative to help decrease the risk of acquiring Pelvic inflammatory disease later in life.

Pelvic inflammatory disease Statistics

  • Over one million women a year in the U.S. develop pelvic inflammatory disease
  • 1/4 of these women will require hospitalization
  • Chlamydia causes 50% of cases of pelvic inflammatory disease in Europe, and 20-30% of cases in the U.S.

Pelvic inflammatory disease Treatment

Gonorrhea is a reportable disease, meaning that a health practitioner must report it the public health department. Due to the potential complications of pelvic inflammatory disease (infertility, ectopic pregnancy and a potential increased risk of ovarian cancers), it is imperative to start an immediate hospitalization or use of antibiotic therapy. Hospitalization is recommended for patients who are pregnant, suspected of having a pelvic abscess, or if the condition is uncertain. Should a physician decide to not hospitalize, a treatment regime of antibiotics is warranted.

Treatment with antimicrobials such as quinolones, cephalosporins or doxycyclines, should be started as soon as possible, post diagnosis.[7] A range of antibiotics would be utilized to deal with the range of infectious agents that may be present. Sexual partners of infected patients must also be treated in order to prevent a re-infection from occuring. However, in today’s age of antibiotic resistant organisms, concurrent treatments using alternative therapies should be used to help enhance immune system function.

Supplements helpful for Pelvic inflammatory disease

General immune support, complementing conventional drug therapies, should be used to enhance white blood cell action. Nutrients, like Vitamin A, vitamin C, vitamin E, and the carotenes, can all be helpful and may limit the potential cell damage from various inflammatory processes. [8] Vitamin C is very useful in treating pelvic inflammatory disease because it helps to prevent pelvic scarring and tissue destruction. [9]

Bromelain Bromelain can be helpful due to its antimicrobial and anti-inflammatory actions. Clinical study has indicated that bromelain may possess the ability to penetrate into the uterus and ovaries, while affording these vulnerable areas protection from certain harmful organisms. [10]

Chlorophyll

Chlorophyll douching can be helpful in inhibiting bacteria and to encourage healing in the upper reproductive tract. [11]

Lactobacillus

Lactobacillus acidophilus should be used with antibiotic therapies to help prevent complications such as vaginal yeast infections. This can be accomplished by wither eating a high quality yogurt product, or by taking an acidophilus supplement.

References

[1] Stenchever. Pelvic Inflammatory Disease. Comprehensive Gynecology, 4th edition. Mosby; 2001:

[2] Washington AE, Arno P, Brooks A. The economic cost of pelvic inflammatory disease. JAMA 1986: 255: 1735-1738.

[3] Westrom L. Effect of acute pelvic inflammatory disease on fertility. Am J Obstet Gynecol. 1975: 121:707.

[4] Ness RB, Hillier SL, Kip KE, Soper DE. Bacterial vaginosis and the risk of pelvic inflammatory disease. Obstet Gynecol 2004 Oct; 104 (4): 761-9.

[5] Centers for Disease Control. Chlamydia screening among sexually active young women enrollees of health plans-U.S. 1999-2001.

[6] Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 2004 Oct; 39 (7): 990-5.

[7] Patel DR. Management of pelvic inflammatory disease in adolescents. Indian J Pediatr 2004 Sept; 71 (9): 845-7.

[8] Alexander M, Newmark H, Miller RG. Oral beta-carotene can increase the number of OKT4+ cells in human blood. Immunol Letters 1985; 9: 221-224.

[9] Ringsdorf W, Cheraskin E. Vitamin C and human wound healing. Oral Surgery 1985; March: 231-233.

[10] Luerti M, Vignali M. Influence of bromelain on penetration of antibiotics in uterus, salpinx and ovary. Drugs Exp Clin Res 1978; 4:45-48.

[11] Gruskin B. Chlorophyll-its therapeutic place in acute and suppurative disease. Am J Surg 1940; XIIX: 49-55.