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Pid
- 2. OUTLINE Definition Epidemiology Risk factors Micro-organism Mode of transmission Pathology Presentation (symptoms &signs) Staging Management Prevention
- 3. Definition PID is a spectrum of inflammatory disordes of upper female genital tract (endometritis, salpingitis, T-O abcess and pelvic peritonitis) PID is inflammatory process of infectious eitiology , which specifically involves at the leat the uterine and /or fallopian sites , and which may result in relatively comparable long term sequelae.
- 5. Epidemiology PID is commonly associated with STDs , incidence is on rise due to rise in STDs Estimates of Annual incidence of PID, acc to WHO is : Between 9.5 to 14 cases /1000 fertile women, with higher rate of 18 to 20 per 1000 among women aged 15 to 24 years . Among sexually active women : incidence is 1-2 % per year.
- 6. Strong evidence Weak evidence 1.Prior infection with chlamydia or gonorrhea 1. Low socio- economic status 2.Younger age at onset of sexual activity . 2.Substance Abuse 3.Prior H/O PID 3.Douching 4.STD 4.Higher frequency of coitus 5Non use of barrier contraceptives 5.Cigarette Smoking 6.Unprotected Sexual intercourse with multiple parter 6.Intercourse during menstruation . Risk factors
- 7. MICROBIAL ETIOLOGY Acute PID most case are polymicrobial
- 8. Mode of Transmission Ascending infection (Canalicular spread) Ascend of gonococcal & chlamydial organism by surface extension from the lower genital tract through cervical canal by way of endometrium to the fallopian tubes . - Facilitated by the sexually transmitted vectors such as sperms & trichor . - reflux of menstrual blood along with gonococci into fallopian tubes may be the other possibility.
- 10. Mode of transmission Through uterine lymphatic and blood vessels across parametrium . - Mycoplasma hominis - Secondary organism Gynecological procedures favoring ascent of infection - D & C , D & E .
- 11. Blood borne transmission -pelvic tuberculosis Direct spread from contaminated structures in abdominal cavity. - appendicitis, cholecystitis
- 17. Examination Abominal examination : show distension combined with tenderness and rigidity in lower abdomen Speculum examination : Shows purulent discharge emanating from cervical canal Bimanual examination : I an acute stage, cervical motion tenderness and tenderness in fornices is elicited
- 18. Fitz Hugh & Cutis syndrome - Consist of right upper quadrant pain resulting from ascending pelvic infection and inflammation of liver capsule or diaphragm. Although it is typically associated with acute salpingitis , it can exist without signs of acute PID.
- 19. Investigations
- 21. Differential diagnosis Women of reproductive age Gastrointestinal – Appendicitis, bowel obstrution , diverticulitis, gastritis , inguninal hernia, irritable bowel syndrome, mesentric venous thrombosis, perirectal abscess. Gynecologic- Adenomyosis, degenerating uterine fibroid , ectopic pregnanacy, endometriosis, mittelschmerz , ovarian torsion , PID, ruptured ovarian cyst, TO abscess. Urinary – Cystitis, pyelonehritis , ureterolithiasis. Others- dissecting aortic aneurysm , lead poisoning, malingring , narcotic seeking , porphyria , sickle cell crisis , somitization disorder
- 22. Pregnant women – Corpus luteum hematoma , ectopic pregnancy , ovarian torsion , ovarian vein thrombosis(postpartum ), placental abruption , uterine impaction . Adolescents- similar to women in reproductive age, imperforated hyem and transverse septum. Postmenopausal women – Similar to women in reproductive age except ectopic pregnancy
- 26. Staging
- 30. Hospital admission (CDC- 2010)criteria Patient meeting following criteria 1. Generalized peritonitis 2.Patient is pregnant 3.Patient does not respond to oral antimicrobial therapy 4.Patient is unable to follow or tolerate an outpatient oral regimen 5.Patient has sever illness , nausea and vomitting or high grade fever 6. Patient has tubo- ovarian abscess 7.WBC>15000/cumm 8.Temperature>101f
- 31. Organism Antibiotics N. Gonorrhea Cephalosporins, Quinolones Chlamydia Doxycycline , Erythromycin &Quinolones Anaerobic Organism Metronidazole, Clindamycin and in some cases to doxycyclin B-Haemolytic Streptococci and e- coli Penincillin derivatives, tetracyclines and cephalosporins
- 37. Management (surgery in acute PID) INDICATIONS 1. Ruptured Abscess 2. Failed response to medical treatment 3.Uncertain diagnosis TYPE OF SURGERIES 1.Colpotomy 2. Percutaneous Drainage /Aspiration 3.Exploratory Lparotomy EXTEND OF SURGERIES 1.Conservation – if fertilty desired 2.U/L or B/L sal. Oophorectomy with / without hysterectomy 3.Drainage of abscess at laparotomy
- 39. Complications Complications of PID 1.Dyspareunia 2.Infertility: due to tubal factor • 12% after single episode • 25% after two episodes • 50% after three episodes 3.Increased risk of ectopic pregnancy • 6-10% increase in risk following H/o PID 4. Formation of adhesions or hydrosalpinx or pyosalpinx and TO abscess 5. Chronic Pelvic inflammation Due to recurrent or associated pyogenic infection /TB 6.Chronic Pelvic pain and ill health
- 40. Prevention PRIMARY PREVENTION 1.Sexual Counscelling • Practice safe sex • Limit number of sexual partners • Avoid contact with high risk partners • Delay in sexual activity untill 18 ears of age 2.Barrier methods and oral contraceptives reduce risk SECONDARY PREVENTION 1. Screening for infections in high risk population 2.Rapid diagnosis & effective treatment of STD & UTI TERTIARY PREVENTION 1. Early intervention and complete treatment