Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an acute infection of the structures of the female upper genital tract that may affect all or part of the uterus, fallopian tubes and/or ovaries. It is a complication of sexually transmitted diseases.

Its development is based on the ascent of germs through the cervix into the uterus, tubes and abdominal cavity.

Signs and symptoms of PID vary depending on the severity of the infection and the infectious organism causing it, and may develop asymptomatically or present with severe abdominal pain, nausea, vomiting and fever. Complications of PID may include infertility or risk of ectopic pregnancy (due to fallopian tube occlusion), presence of pus collections (abscesses) in the tubes, ovaries or pelvic cavity. In severe cases, a generalised infection or sepsis may develop, which can be life-threatening.

The diagnosis should be suspected by interrogation and is confirmed by the results of cultures for the diagnosis of infection. An abdominal and gynaecological examination should usually be performed to determine the location of the abdominal pain. Transvaginal ultrasound is often necessary to detect the presence of pelvic abscesses. A blood test can detect the presence of infection markers, such as elevated white blood cells or C-reactive protein, which will help guide the diagnosis.

PID is treated with antibiotics specifically targeted at the infecting organism, most often chlamydia, gonorrhoea or a combination of infectious organisms. Mild infections can be treated on an outpatient basis by taking antibiotics for two weeks. Severe cases may require hospital admission for observation and intravenous antibiotics. If there are abscesses in the pelvis, surgery may be necessary to drain these collections.